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- Title
Effect of pregnancy on HIV disease progression and survival among women in rural Uganda.
- Authors
Van der Paal, Lieve; Shafer, Leigh Anne; Mayanja, Billy N.; Whitworth, Jimmy A. G.; Grosskurth, Heiner
- Abstract
Objective To investigate the effect of pregnancy on HIV disease progression and survival among HIV-infected women in rural Uganda, prior to the introduction of anti-retroviral therapy (ART). Methods From a clinical cohort established in 1990, we selected records from HIV-infected women of reproductive age. We conducted two analyses: (1) all HIV-infected cases contributing to analysis of CD4 decline, using a linear regression model with random intercepts and slopes; (b) incident cases with known date of seroconversion contributed to analyses of median time to CD4 <200 cells/ μl, AIDS and death. Results A total of 139 women were included in the analysis of CD4 decline. Women who subsequently became pregnant had higher CD4 counts at enrolment and had a slower CD4 decline than those who did not become pregnant. In women who became pregnant, CD4 decline was faster after pregnancy than before ( P < 0.0001). The survival analyses showed no significant differences between women who became pregnant and those who did not with respect to median time to CD4 count <200, AIDS or death. Conclusions The initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy. Women should be informed about the potential negative effect of pregnancy on their immunological status and should be offered contraception. In resource-limited settings, women determined to become pregnant should be given priority for ART if eligible.
- Publication
Tropical Medicine & International Health, 2007, Vol 12, Issue 8, p920
- ISSN
1360-2276
- Publication type
Academic Journal
- DOI
10.1111/j.1365-3156.2007.001873.x