Women with HIV tend to have fewer babies. Are they less likely to get pregnant? Or do they have a greater risk of miscarriage or stillbirth? Researchers at the UK Medical Research Council Programme on AIDS in Uganda tried to answer these questions by following a group of 191 women in the south-west of the country.

They offered routine clinic visits every three months to 92 HIV-positive and 99 negative women over nearly 11 years. During this time, there were 216 pregnancies in 104 women. Analysing data, including HIV status and the incidence and outcomes of pregnancies, the researchers report that:

• 40 percent of the HIV-positive women had died by the end of the study.
• The frequency of sexual intercourse decreases with advancing HIV disease.
• Overall, the odds of a woman with HIV being pregnant are around half those for HIV-negative women.
• The likelihood of pregnancy decreases as the disease worsens, whether this is measured by clinical stage, CD4 count (the immune status of a patient), time from becoming HIV-positive or time before an AIDS diagnosis. There are very few pregnancies in the advanced stages of the disease.
• There were 183 live births, 21 spontaneous abortions and 12 stillbirths or early neonatal deaths. HIV-infected women have a higher risk of foetal loss, even at the earliest stages of HIV infection.

This study shows that fertility decreases from the earliest stage of HIV infection, due to fewer pregnancies and increased foetal loss. This information will help to predict numbers of orphans due to AIDS and the rates of HIV infection in children. It also shows that the estimation of general HIV rates from antenatal clinic (ANC) data is not as straightforward as it seems. If HIV-positive women have lower fertility, they are less likely to attend ANC, and so these data may underestimate HIV rates in the general population. However, other studies have shown that women with lower fertility are more likely to become HIV-infected. Possible explanations include illness in their partners, other sexually transmitted infections, or the cultural pressure for women to have children in many African societies may push them towards more risky behaviour, such as having extra sexual partners.

Source(s):
‘HIV-1 disease progression and fertility: the incidence of recognized pregnancy and pregnancy outcome in Uganda’, AIDS 18: 799-804, by A. Ross, et al, 2004
HINARI subscribers can access the full-text article here. Full document.

Funded by: UK Medical Research Council; UK Department for International Development

id21 Research Highlight: 23 February 2005

Further Information:
Amanda Ross
Department of Public Health and Epidemiology
Swiss Tropical Institute
Socinstrasse 57
CH-4002 Basel
Switzerland

Tel: +41 61 284 81 12
Fax: +41 61 271 79 51
Contact the contributor: amanda.ross@unibas.ch

UK Medical Research Council Programme on AIDS, Uganda

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