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Published in: AIDS and Behavior 12/2018

Open Access 01-12-2018 | Original Paper

Effect of the Number of Pregnancies on Mortality Risk in HIV-Infected Women: a Prospective Cohort Study in Rural KwaZulu-Natal, South Africa

Authors: Hyunsuk Yoo, Juyeon Lee, Jae-Joon Yim, Till Bärnighausen, Frank Tanser, Sue K. Park

Published in: AIDS and Behavior | Issue 12/2018

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Abstract

We investigated whether mortality risk increases with the number of full-term pregnancies in HIV-infected women. Our study is based on data from the ACDIS cohort, collected in rural KwaZulu-Natal, South Africa. Mortality risk for different number of pregnancies in HIV-infected women was analyzed using Cox proportional hazards model. The risk of TB or AIDS mortality in HIV-uninfected women did not change with the number of full-term pregnancies, while the corresponding risk increased markedly in HIV-infected women. The risk of TB or AIDS mortality increased 1.48-fold (95% CI 1.25–1.75), 1.76-fold (95% CI 1.45–2.13), and 1.59-fold (95% CI 1.31–1.94) for one, two, and three or more full-term pregnancies compared to none, respectively. Finally, women who are young (age < 26) have greater risk of TB or AIDS mortality compared to women who are old (age ≥ 26), and women residing in rural areas have greater risk compared to women who reside in non-rural areas.
Literature
1.
go back to reference Hosegood V, Vanneste A-M, Timæus IM. Levels and causes of adult mortality in rural South Africa: the impact of AIDS. AIDS. 2004;18(4):663–71.CrossRef Hosegood V, Vanneste A-M, Timæus IM. Levels and causes of adult mortality in rural South Africa: the impact of AIDS. AIDS. 2004;18(4):663–71.CrossRef
2.
go back to reference Calvert C, Ronsmans C. The contribution of HIV to pregnancy-related mortality: a systematic review and meta-analysis. AIDS. 2013;27(10):1631–9.CrossRef Calvert C, Ronsmans C. The contribution of HIV to pregnancy-related mortality: a systematic review and meta-analysis. AIDS. 2013;27(10):1631–9.CrossRef
3.
go back to reference Calvert C, Ronsmans C. Pregnancy and HIV disease progression: a systematic review and meta-analysis. Trop Med Int Health. 2015;20(2):122–45.CrossRef Calvert C, Ronsmans C. Pregnancy and HIV disease progression: a systematic review and meta-analysis. Trop Med Int Health. 2015;20(2):122–45.CrossRef
4.
go back to reference Buchacz K, Baker RK, Palella FJJ, Chmiel JS, Lichtenstein KA, Novak RM, et al. AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study. AIDS. 2010;24(10):1549–59.CrossRef Buchacz K, Baker RK, Palella FJJ, Chmiel JS, Lichtenstein KA, Novak RM, et al. AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study. AIDS. 2010;24(10):1549–59.CrossRef
5.
go back to reference Abdool Karim SS, Churchyard GJ, Abdool Karim Q, Lawn SD. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet. 2009;374(9693):921–33.CrossRef Abdool Karim SS, Churchyard GJ, Abdool Karim Q, Lawn SD. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet. 2009;374(9693):921–33.CrossRef
6.
go back to reference Houlihan CF, Mutevedzi PC, Lessells RJ, Cooke GS, Tanser FC, Newell M-L. The tuberculosis challenge in a rural South African HIV programme. BMC Infect Dis. 2010;10(1):23.CrossRef Houlihan CF, Mutevedzi PC, Lessells RJ, Cooke GS, Tanser FC, Newell M-L. The tuberculosis challenge in a rural South African HIV programme. BMC Infect Dis. 2010;10(1):23.CrossRef
7.
go back to reference Lathrop E, Jamieson DJ, Danel I. HIV and maternal mortality. Int J Gynecol Obstet. 2014;127(2):213–5.CrossRef Lathrop E, Jamieson DJ, Danel I. HIV and maternal mortality. Int J Gynecol Obstet. 2014;127(2):213–5.CrossRef
8.
go back to reference Moran NF, Moodley J. The effect of HIV infection on maternal health and mortality. Int J Gynecol Obstet. 2012;119:S26–9.CrossRef Moran NF, Moodley J. The effect of HIV infection on maternal health and mortality. Int J Gynecol Obstet. 2012;119:S26–9.CrossRef
9.
go back to reference Zaba B, Calvert C, Marston M, Isingo R, Nakiyingi-Miiro J, Lutalo T, et al. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). The Lancet. 2013;381(9879):1763–71.CrossRef Zaba B, Calvert C, Marston M, Isingo R, Nakiyingi-Miiro J, Lutalo T, et al. Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). The Lancet. 2013;381(9879):1763–71.CrossRef
10.
go back to reference Tanser F, Hosegood V, Bärnighausen T, Herbst K, Nyirenda M, Muhwava W, et al. Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol. 2008;37(5):956–62.CrossRef Tanser F, Hosegood V, Bärnighausen T, Herbst K, Nyirenda M, Muhwava W, et al. Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol. 2008;37(5):956–62.CrossRef
11.
go back to reference Zaidi J, Grapsa E, Tanser F, Newell M-L, Bärnighausen T. Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment. AIDS. 2013;27(14):2301–5.CrossRef Zaidi J, Grapsa E, Tanser F, Newell M-L, Bärnighausen T. Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment. AIDS. 2013;27(14):2301–5.CrossRef
12.
go back to reference Tanser F, Bärnighausen T, Grapsa E, Zaidi J, Newell M-L. High coverage of ART associated with decline in risk of HIV Acquisition in rural KwaZulu-Natal, South Africa. Science. 2013;339(6122):966–71.CrossRef Tanser F, Bärnighausen T, Grapsa E, Zaidi J, Newell M-L. High coverage of ART associated with decline in risk of HIV Acquisition in rural KwaZulu-Natal, South Africa. Science. 2013;339(6122):966–71.CrossRef
13.
go back to reference McGrath N, Eaton JW, Newell M-L, Hosegood V. Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa. Lancet HIV. 2015;2(6):e252–9.CrossRef McGrath N, Eaton JW, Newell M-L, Hosegood V. Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa. Lancet HIV. 2015;2(6):e252–9.CrossRef
14.
go back to reference WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: WHO; 2016. WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: WHO; 2016.
15.
go back to reference Johnson LF, Rehle TM, Jooste S, Bekker L-G. Rates of HIV testing and diagnosis in South Africa: successes and challenges. AIDS. 2015;29(11):1401–9.CrossRef Johnson LF, Rehle TM, Jooste S, Bekker L-G. Rates of HIV testing and diagnosis in South Africa: successes and challenges. AIDS. 2015;29(11):1401–9.CrossRef
16.
go back to reference Spence NJ. The long-term consequences of childbearing: physical and psychological well-being of mothers in later life. Res Aging. 2008;30(6):722–51.CrossRef Spence NJ. The long-term consequences of childbearing: physical and psychological well-being of mothers in later life. Res Aging. 2008;30(6):722–51.CrossRef
17.
go back to reference Grundy E, Holt G. Adult life experiences and health in early old age in Great Britain. Soc Sci Med. 2000;51(7):1061–74.CrossRef Grundy E, Holt G. Adult life experiences and health in early old age in Great Britain. Soc Sci Med. 2000;51(7):1061–74.CrossRef
18.
go back to reference Grundy E, Tomassini C. Fertility history and health in later life: a record linkage study in England and Wales. Soc Sci Med. 2005;61(1):217–28.CrossRef Grundy E, Tomassini C. Fertility history and health in later life: a record linkage study in England and Wales. Soc Sci Med. 2005;61(1):217–28.CrossRef
19.
go back to reference MacCarthy S, Laher F, Nduna M, Farlane L, Kaida A. Responding to her question: a review of the influence of pregnancy on HIV disease progression in the context of expanded access to HAART in Sub-Saharan Africa. AIDS Behav. 2009;13(1):66–71.CrossRef MacCarthy S, Laher F, Nduna M, Farlane L, Kaida A. Responding to her question: a review of the influence of pregnancy on HIV disease progression in the context of expanded access to HAART in Sub-Saharan Africa. AIDS Behav. 2009;13(1):66–71.CrossRef
20.
go back to reference Kourtis AP, Read JS, Jamieson DJ. Pregnancy and Infection. N Engl J Med. 2014;370(23):2211–8.CrossRef Kourtis AP, Read JS, Jamieson DJ. Pregnancy and Infection. N Engl J Med. 2014;370(23):2211–8.CrossRef
21.
go back to reference Koyanagi A, Ruff AJ, Moulton LH, Ntozini R, Mutasa K, Iliff P, et al. Postpartum plasma CD4 change in HIV-positive women: implications for Timing of HAART initiation. AIDS Res Hum Retroviruses. 2010;26(5):547–52.CrossRef Koyanagi A, Ruff AJ, Moulton LH, Ntozini R, Mutasa K, Iliff P, et al. Postpartum plasma CD4 change in HIV-positive women: implications for Timing of HAART initiation. AIDS Res Hum Retroviruses. 2010;26(5):547–52.CrossRef
22.
go back to reference McIntyre J. Mothers infected with HIV reducing maternal death and disability during pregnancy. Br Med Bull. 2003;67(1):127–35.CrossRef McIntyre J. Mothers infected with HIV reducing maternal death and disability during pregnancy. Br Med Bull. 2003;67(1):127–35.CrossRef
23.
go back to reference Gounder CR, Wada NI, Kensler C, Violari A, McIntyre J, Chaisson RE, et al. Active tuberculosis case-finding among pregnant women presenting to antenatal clinics in Soweto, South Africa. J Acquir Immune Defic Syndr. 2011;57(4):e77–84.CrossRef Gounder CR, Wada NI, Kensler C, Violari A, McIntyre J, Chaisson RE, et al. Active tuberculosis case-finding among pregnant women presenting to antenatal clinics in Soweto, South Africa. J Acquir Immune Defic Syndr. 2011;57(4):e77–84.CrossRef
24.
go back to reference Gorman SE. A new approach to maternal mortality: the role of HIV in pregnancy. Int J Womens Health. 2013;5:271–4.CrossRef Gorman SE. A new approach to maternal mortality: the role of HIV in pregnancy. Int J Womens Health. 2013;5:271–4.CrossRef
25.
go back to reference Ardington C, Menendez A, Mutevedzi T. Early childbearing, human capital attainment and mortality risk: evidence from a longitudinal demographic surveillance area in rural-KwaZulu-Natal, South Africa. Econ Dev Cult Change. 2015;63(2):281–317.CrossRef Ardington C, Menendez A, Mutevedzi T. Early childbearing, human capital attainment and mortality risk: evidence from a longitudinal demographic surveillance area in rural-KwaZulu-Natal, South Africa. Econ Dev Cult Change. 2015;63(2):281–317.CrossRef
26.
go back to reference Chaiyachati K, Hirschhorn LR, Tanser F, Newell M-L, Bärnighausen T. Validating five questions of antiretroviral nonadherence in a public-sector treatment program in rural South Africa. AIDS Patient Care STDs. 2011;25(3):163–70.CrossRef Chaiyachati K, Hirschhorn LR, Tanser F, Newell M-L, Bärnighausen T. Validating five questions of antiretroviral nonadherence in a public-sector treatment program in rural South Africa. AIDS Patient Care STDs. 2011;25(3):163–70.CrossRef
27.
go back to reference Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis. 2000;30(Supplement_2):S171–6.CrossRef Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis. 2000;30(Supplement_2):S171–6.CrossRef
28.
go back to reference Buseh AG, Glass LK, McElmurry BJ. Cultural and gender issues related to HIV/AIDS prevention in rural Swaziland: a focus group analysis. Health Care Women Int. 2002;23(2):173–84.CrossRef Buseh AG, Glass LK, McElmurry BJ. Cultural and gender issues related to HIV/AIDS prevention in rural Swaziland: a focus group analysis. Health Care Women Int. 2002;23(2):173–84.CrossRef
Metadata
Title
Effect of the Number of Pregnancies on Mortality Risk in HIV-Infected Women: a Prospective Cohort Study in Rural KwaZulu-Natal, South Africa
Authors
Hyunsuk Yoo
Juyeon Lee
Jae-Joon Yim
Till Bärnighausen
Frank Tanser
Sue K. Park
Publication date
01-12-2018
Publisher
Springer US
Published in
AIDS and Behavior / Issue 12/2018
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-018-2232-0

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