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

Uganda Virus Research Institute, Entebbe, Central Region, Uganda
AIDS (Impact Factor: 5.55). 04/2004; 18(5):799-804. DOI: 10.1097/00002030-200403260-00012
Source: PubMed


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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    • "The relation between HIV infection and fertility is far from being straightforward. Most previous studies on the effect of HIV on pregnancy rates, conducted prior to widespread availability of antiretroviral treatment (ART), suggest reduced fertility due to HIV at population level [5] [6] and individual level [7] with an exception of a few studies that did not find any association between HIV infection and reduction in pregnancy rates [8]. There is emerging literature on fertility among HIV infected women who have access to ART. "
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    ABSTRACT: This is the first study to examine the behavioural effect of HIV on fertility among HIV infected women in India. Retrospective calendar data from ever-married HIV infected women between 15 and 45 years of age, attending a specialized HIV clinic in Pune, Western India , were analysed. Directly standardized overall and parity-specific pregnancy rates were compared among HIV infected women before and after coming to know about their HIV status. The age- and parity-standardized pregnancy rates and age-standardized parity-specific pregnancy rates were statistically significantly lower after knowing about HIV status as compared to before the HIV status was known. Analysis of parity-specific rates suggested lower likelihood of HIV infected women to progress to higher parity. The clear behavioural impact of HIV on fertility observed should be taken into account while estimating HIV infected pregnant women in the country. Ensuring access to information and services for PMTCT to HIV infected couples is essential to support informed reproductive decision making among them.
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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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    • "In the absence of anti-retroviral therapy (ART), women infected with HIV (Human Immunodeficiency Syndrome) have both a physiologically reduced risk of pregnancy, and an elevated risk of pregnancy loss (Ross 2004; Lewis 2004; Gray 1998). With ART becoming increasingly available across Africa, both fecundity and fertility desires among HIV+ women have rebounded (Meyer 2010; Maier 2009). "
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