Population-based study of fertility in women with HIV-1 infection in Uganda
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Date
1998
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Lancet
Abstract
Background To assess the effects of HIV-1 and other
sexually transmitted infections on pregnancy, we undertook
cross-sectional and prospective studies of a rural population
in Rakai district, Uganda.
Methods 4813 sexually active women aged 15–49 yearswere surveyed to find out the prevalence of pregnancy by
interview and selective urinary human chorionic gonadotropin
tests. The incidence of recognised conception and frequency
of pregnancy loss were assessed by follow-up. Samples were
taken to test for HIV-1 infection, syphilis, and other sexually
transmitted diseases.
Findings At time of survey, 757 (21·4%) of 3544 women
without HIV-1 infection or syphilis were pregnant, compared
with 46 (14·6%) of 316 HIV-1-negative women with active
syphilis, 117 (14·2%) of 823 HIV-1-positive women with no
concurrent syphilis, and 11 (8·5%) of 130 women with both
syphilis and HIV-1 infection. The multivariate adjusted odds
ratio of pregnancy in HIV-1-infected women was 0·45 (95%
CI 0·35–0·57); the odds of pregnancy were low both in HIV-1-
infected women without symptoms (0·49 [0·39–0·62]) and
in women with symptoms of HIV-1-associated disease (0·23
[0·11–0·48]). In women with concurrent HIV-1 infection and
syphilis the odds ratio was 0·28 (0·14–0·55). The incidence
rate of recognised pregnancy during the prospective followup study was lower in HIV-1-positive than in HIV-1-negative
women (23·5 vs 30·1 per 100 woman-years; adjusted risk
ratio 0·73 [0·57–0·93]). Rates of pregnancy loss were higher
among HIV-1-infected than uninfected women (18·5 vs
12·2%; odds ratio 1·50 [1·01–2·27]). The prevalence of
HIV-1 infection was significantly lower in pregnant than in
non-pregnant women (13·9 vs 21·3%).
Interpretation Pregnancy prevalence is greatly reduced in
HIV-1-infected women, owing to lower rates of conception
and increased rates of pregnancy loss. HIV-1 surveillance
confined to pregnant women underestimates the magnitude
of the HIV-1 epidemic in the general population
Description
Keywords
Fertility, Women, HIV-1 infection, Uganda
Citation
Gray, R. H., Wawer, M. J., Serwadda, D., Sewankambo, N., Li, C., Wabwire-Mangen, F., ... & McNairn, D. (1998). Population-based study of fertility in women with HIV-1 infection in Uganda. The lancet, 351(9096), 98-103.