HIV-1 disease progression and fertility: the incidence of recognized pregnancy and pregnancy outcome in Uganda

KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230, Kilifi, Kenya.
AIDS (Impact Factor: 6.56). 04/2004; 18(5):799-804. DOI: 10.1097/00002030-200403260-00012
Source: PubMed

ABSTRACT To estimate the association between HIV disease progression and the incidence of recognized pregnancy; to estimate the risk of subsequent fetal loss.
A total of 191 women (92 HIV seropositive and 99 HIV seronegative at enrolment) aged 15-49 years in an HIV clinical cohort were invited to attend routine clinic visits every 3 months. Information on HIV progression collected at the visit was related to whether there was a pregnancy beginning in the following 3 months. Visits were excluded where the woman was already pregnant, lactating, using modern contraceptives or if there was inadequate follow-up.
There were 2524 eligible visits and 216 recognized pregnancies. The reported frequency of sexual intercourse diminished with advancing HIV disease. The adjusted odds ratio (OR) for pregnancy when the woman was in WHO stage 1 compared with HIV seronegatives was 0.58 [95% confidence interval (CI), 0.36-0.93]; stage 2, 0.47 (95% CI, 0.25-0.91); stage 3, 0.43 (95% CI, 0.25-0.74); and stage 4, (AIDS) 0.14 (95% CI, 0.02-1.09). The findings were similar for CD4 cell count, time from seroconversion and time before AIDS. There was an increase in fetal loss from the early stages of HIV infection (adjusted OR for stage 1, 5.38; 95% CI, 1.57-18.44), there were very few recognized pregnancies in the advanced stages.
Fertility is reduced from the earliest asymptomatic stage of HIV infection resulting from both a reduced incidence of recognized pregnancy and increased fetal loss. The greatest reduction in fertility was observed following progression to AIDS when there was a very low incidence of recognized pregnancies.

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    • "These data contributed to global estimates and projections of HIV infections. Natural history cohort data also showed that in women who became pregnant, CD4 cell count decline was significantly faster after pregnancy than before (Paal et al. 2007); that malaria had little detrimental effect on risk of death among HIV-infected people (Quigley et al. 2005); and that fertility is reduced from the earliest asymptomatic stage of HIV infection as a result of both a reduced incidence of recognised pregnancy and a increased fetal loss (Ross et al. 2004). Results from a double-blind, randomized, placebocontrolled trial of the 23-valent pneumococcal vaccine in HIV-1-infected people in the Entebbe cohort showed no benefit in preventing pneumococcal disease in this population (French et al. 2000). "
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    ABSTRACT: For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south.
    Tropical Medicine & International Health 10/2014; 20(2). DOI:10.1111/tmi.12415
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    • "Reduced fertility among HIV-positive women has been reported in sub-Saharan Africa [3] [4] [5] [6] [7]. Fertility is not impaired during early HIV infection [8] [9] but declines with disease progression, and the reduction is greatest with onset of AIDS [10]. The mechanisms through which fertility rates are reduced by HIV are not fully understood, but higher viral load and decreased CD4 counts with advanced HIV disease are likely to be implicated [11]. "
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    ABSTRACT: Background. Use of antiretroviral therapy (ART) may be associated with higher pregnancy rates. Methods. The prevalence and incidence of pregnancy was assessed in 712 HIV+ pre-ART women of reproductive age (WRA) (15–45) and 244 HIV+ WRA initiating ART. Prevalence rate ratios (PRR), incidence rate ratios (IRR), and 95% confidence interval (CI) were assessed. Results. The incidence of pregnancy was 13.1/100 py among women in pre-ART care compared to 24.6/100 py among women on ART (IRR = 0.54; 95% CI 0.37, 0.81, p < 0.0017). The prevalence of pregnancy at ART initiation was 12.0% with CD4 counts 100–250 compared with 3.2% with CD4 <100 (PRR = 3.24, CI 1.51–6.93), and the incidence of pregnancy while on ART was highest in women with a good immunologic response. Desire for more children was a very important factor in fertility. Conclusion. ART was associated with increased pregnancy rates in HIV+ women, particularly those with higher CD4 counts and good immunologic response to therapy, suggesting a need to strengthen reproductive health services for both women and their partners that could address their fertility decisions/intentions particularly after ART initiation.
    AIDS research and treatment 01/2011; 2011:519492. DOI:10.1155/2011/519492
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    • "Several studies have shown that women generally have fewer sexual partners as they enter the later stages of HIV disease (Ross et al. 2004; Terceira et al. 2003; Hankins, Tran, and Lapointe 1998; Greenblatt et al. 1999), but the initiation of highly active antiretroviral treatment (HAART) is associated with a restoration of health and a resumption of sexual activity (Bunnell et al. 2006; Moatti et al. 2003). It is therefore assumed that the rates of partner acquisition stated previously are reduced by specified multiples (shown in Table 2) after individuals develop HIV-related symptoms. "
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    ABSTRACT: This paper aims to quantify the effects of different types of sexual risk behaviour on the spread of HIV in South Africa. A mathematical model is developed to simulate changes in numbers of sexual partners, changes in marital status, changes in commercial sex activity and changes in the frequency of unprotected sex over the life course. This is extended to allow for the transmission of HIV, and the model is fitted to South African HIV prevalence data and sexual behaviour data. Results suggest that concurrent partnerships and other non-spousal partnerships are major drivers of the HIV/AIDS epidemic in South Africa.
    Demographic Research 07/2009; 21. DOI:10.4054/DemRes.2009.21.11
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