Impact of Antiretroviral Therapy on Incidence of Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort Study

Myer, Landon; Carter, Rosalind J.; Katyal, Monica; Toro, Patricia Lasso; El‐Sadr, Wafaa; Abrams, Elaine J.

doi:10.1371/journal.pmed.1000229

Cited by 188 publications

(214 citation statements)

References 31 publications

(40 reference statements)

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“…However, rather than a direct effect of age, the lower prevalence among older pregnant women may primarily be associated with reduced fertility during later stages of HIV infection [5,[14][15][16][17]. This distinction is potentially important because of its interaction with the stages of the HIVepidemic -during the early exponential growth period of the epidemic, many more women are recently infected, and so HIV-related subfertility will be lower than later in the epidemic, even among older women.…”

Section: Introductionmentioning

confidence: 99%

The effects of HIV on fertility by infection duration

Marston

Nakiyingi‐Miiro

Kusemererwa

et al. 2017

Aids

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on behalf of the ALPHA network 1 Objectives: To estimate the relationship between HIV natural history and fertility by duration of infection in east and southern Africa before the availability of antiretroviral therapy and assess potential biases in estimates of age-specific subfertility when using retrospective birth histories in cross-sectional studies.Design: Pooled analysis of prospective population-based HIV cohort studies in Masaka (Uganda), Kisesa (Tanzania) and Manicaland (Zimbabwe).Methods: Women aged 15-49 years who had ever tested for HIV were included. Analyses were censored at antiretroviral treatment roll-out. Fertility rate ratios were calculated to see the relationship of duration of HIV infection on fertility, adjusting for background characteristics. Survivorship and misclassification biases on age-specific subfertility estimates from cross-sectional surveys were estimated by reclassifying person-time from the cohort data to simulate cross-sectional surveys and comparing fertility rate ratios with true cohort results.Results: HIV-negative and HIV-positive women contributed 15 440 births and 86 320 person-years; and 1236 births and 11 240 000 person-years, respectively, to the final dataset. Adjusting for age, study site and calendar year, each additional year since HIV seroconversion was associated with a 0.02 (95% confidence interval 0.01-0.03) relative decrease in fertility for HIV-positive women. Survivorship and misclassification biases in simulated retrospective birth histories resulted in modest underestimates of subfertility by 2-5% for age groups 20-39 years.Conclusion: Longer duration of infection is associated with greater relative fertility reduction for HIV-positive women. This should be considered when creating estimates for HIV prevalence among pregnant women and prevention of mother-to-child transmission need over the course of the HIV epidemic and antiretroviral treatment scale up.

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Section: Introductionmentioning

confidence: 99%

The effects of HIV on fertility by infection duration

Marston

Nakiyingi‐Miiro

Kusemererwa

et al. 2017

Aids

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“…HIV transmission risk in patients on HAART is low only if the following conditions are met: the HIV-infected patient is receiving HAART with excellent adherence; patients disclose their HIV status and inquire about HIV status of their sexual partners; the viral load is consistently undetectable for a long time; and no sexually transmitted infections (STIs) are present in either partners. The above conditions are not met in many sub-Saharan African settings, as many studies [56][57][58][59][60][61] report that sub-optimal adherence, high fertility intentions, and risk factors for acquisition of STI (such as multiple sexual partners, and inconsistent condom use) are common. In many settings in sub-Saharan Africa, such as eastern and southern Africa, high-risk behaviors occur in HIV patients before and after initiating HAART [62][63][64][65].…”

Section: Discussionmentioning

confidence: 99%

The impact of highly active antiretroviral therapy on high-risk behaviour of HIV-infected patients in sub-Saharan Africa

Kaye

Kakaire

Osinde

et al. 2013

J Infect Dev Ctries

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Introduction: High-risk sexual behaviors such as multiple sexual partners, inconsistent condom use, acquisition of sexually transmitted infection (STIs), and non-use of contraceptives persist in HIV patients undergoing care. We conducted a systematic review of studies conducted in the era of increased access to HAART (2000HAART ( -2010 to assess whether wide-scale use of HAART was associated with high-risk behavior among HAART-using patients. Methodology: We conducted a comprehensive search of databases (AIDSLINE, National Library of Medicine, MEDLINE, PubMed, CINHAL and EMBASE) from January 2002 to January 2010, reviewed conference proceedings and journals, and contacted the researchers involved. We analyzed the association of high-risk behaviors (non-disclosure of sero-status to sexual partners, inconsistent condom use, unprotected sexual intercourse, multiple sexual partners, non-use of contraceptives and acquisition of STIs) with using HAART. Information from eligible studies was abstracted using a standardized checklist. Fourteen English-language studies met the selection criteria of having high-risk behavior as an outcome in patients using HAART in sub-Saharan Africa. Results: Of the 92 eligible articles screened, 14 met the criteria for inclusion as primary articles, 10 showed that HAART is not associated with increased high-risk behavior, two showed increase in acquisition of STIs among HAART-using patients, (which was inconsistent with other measures of high-risk behavior), and two studies showed short-term increase in high-risk behavior. Conclusions: Persistence of high-risk behavior in HAART-using patients suggests that more effort needs to be incorporated in HIV care to reduce such behavior to reduce HIV transmission to uninfected populations.

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“…Eligibility for ART was based on the clinical stage of the disease and the CD4 cell count (ART was started when <200 cells per mm 3 ).…”

Section: Methodsmentioning

confidence: 99%

“…an AIDS-defining illness. Women were considered to have immunological failure when the CD4 cell count rose to a maximum and then dropped by 50% or more during follow-up, dropped to 100 cells per mm 3 or less, or returned to the baseline value at initiation of ART. AIDS-related mortality was defined as a death that was attributed to HIV/AIDS.…”

Section: Methodsmentioning

confidence: 99%

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Effect of subsequent pregnancies on HIV disease progression among women in the Mulago Hospital MTCT-Plus program in Uganda

Amongin

Nakimuli

Busingye

et al. 2015

International Journal of Gynecology & Obstetrics

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Objective-To investigate the effect of subsequent pregnancies on HIV disease progression among HIV-infected women at Mulago Hospital, Uganda.Methods-In a retrospective cohort study, data were analyzed from women enrolled in the Mother-To-Child Transmission Plus program from March 2003 to December 2011. The CD4 cell count, the development of new AIDS-defining opportunistic infections, and the AIDS-related mortality were compared between women with and without subsequent pregnancies.Results-Overall, 409 women were enrolled and 195 (47.7%) had subsequent pregnancies. Antiretroviral therapy (ART) was initiated in 143 (73.3%) women with and 155 (72.4%) women without subsequent pregnancies. Kaplan-Meier analysis for women receiving ART showed no differences between women with and without subsequent pregnancies in the median times to clinical failure (62.7 vs 64.7 months; P = 0.31), immunological failure (68.8 vs 75.5 months; P = 0.10), and death (68.8 vs 75.5 months; P = 0.53). In a Cox regression analysis, subsequent pregnancies were not associated with immunological failure during follow-up (adjusted hazard ratio 1.13, 95% confidence interval 0.06-2.09).Conclusion-Subsequent pregnancies could have no detrimental effect on HIV disease progression among HIV-infected women whose treatment is well managed.

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Impact of Antiretroviral Therapy on Incidence of Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort Study

Abstract: A multicountry cohort study in sub-Saharan Africa by Landon Myer and colleagues reveals higher pregnancy rates in HIV-infected women on antiretroviral therapy (ART).

Cited by 188 publications

References 31 publications

The effects of HIV on fertility by infection duration

The effects of HIV on fertility by infection duration

The impact of highly active antiretroviral therapy on high-risk behaviour of HIV-infected patients in sub-Saharan Africa

Effect of subsequent pregnancies on HIV disease progression among women in the Mulago Hospital MTCT-Plus program in Uganda

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