Population-based study of fertility in women with HIV-1 infection in Uganda

Ronald H. Gray, Maria J. Wawer, David Serwadda, Nelson Sewankambo, Chuanjun Li, Frederick Wabwire-Mangen, Lynn Paxton, Noah Kiwanuka, Godfrey Kigozi, Joseph Konde-Lule, Thomas C. Quinn, Charlotte A. Gaydos, Denise McNairn

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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 years were 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 follow-up 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.

Original languageEnglish (US)
Pages (from-to)98-103
Number of pages6
JournalLancet
Volume351
Issue number9096
DOIs
StatePublished - Jan 10 1998

ASJC Scopus subject areas

  • Medicine(all)

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    Gray, R. H., Wawer, M. J., Serwadda, D., Sewankambo, N., Li, C., Wabwire-Mangen, F., Paxton, L., Kiwanuka, N., Kigozi, G., Konde-Lule, J., Quinn, T. C., Gaydos, C. A., & McNairn, D. (1998). Population-based study of fertility in women with HIV-1 infection in Uganda. Lancet, 351(9096), 98-103. https://doi.org/10.1016/S0140-6736(97)09381-1