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Published in: AIDS and Behavior 1/2009

01-06-2009 | Original Paper

Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, among HIV+ Women in an Early HIV Treatment Program in Rural Uganda

Authors: Marissa Maier, Irene Andia, Nneka Emenyonu, David Guzman, Angela Kaida, Larry Pepper, Robert Hogg, David R. Bangsberg

Published in: AIDS and Behavior | Special Issue 1/2009

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Abstract

To assess the association between antiretroviral therapy (ART) and fertility history and desire among HIV-positive Ugandan women, we conducted a cross-sectional study among HIV-positive Ugandan women aged 18–50 years who attended an HIV clinic at Mbarara University in western Uganda between November 1, 2005 and June 6, 2006. Of 538 women approached, 501 were enrolled. ART use was associated with increased odds of fertility desire (AOR 2.99, 95% CI 1.38–6.28), and decreased odds of pregnancy (AOR 0.56, 95% CI 0.33–0.95) and live birth (AOR 0.30, 95% CI 0.13–0.66). ART was associated with an increase in fertility desire, but was not associated with an increase in fertility. Additional studies will be needed to determine if this greater fertility desire among ART-treated women leads to an increase in fertility as ART use expands.
Literature
go back to reference Badri, M., Lawn, S. D., & Wood, R. (2006). Short-term risk of AIDS or death in people infected with HIV-1 before antiretroviral therapy in South Africa: A longitudinal study. The Lancet, 368(9543), 1254–1259.CrossRef Badri, M., Lawn, S. D., & Wood, R. (2006). Short-term risk of AIDS or death in people infected with HIV-1 before antiretroviral therapy in South Africa: A longitudinal study. The Lancet, 368(9543), 1254–1259.CrossRef
go back to reference Badri, M., Wilson, D., & Wood, R. (2002). Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: A cohort study. The Lancet, 359(9323), 2059–2064.CrossRef Badri, M., Wilson, D., & Wood, R. (2002). Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: A cohort study. The Lancet, 359(9323), 2059–2064.CrossRef
go back to reference Bateganya, M., Colfax, G., Shafer, L. A., Kityo, C., Mugyenyi, P., Serwadda, D., Mayanja, H., & Bangsberg, D. (2005). Antiretroviral therapy and sexual behavior: A comparative study between antiretroviral- naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda. AIDS Patient Care and STDS, 19(11), 760–768.PubMedCrossRef Bateganya, M., Colfax, G., Shafer, L. A., Kityo, C., Mugyenyi, P., Serwadda, D., Mayanja, H., & Bangsberg, D. (2005). Antiretroviral therapy and sexual behavior: A comparative study between antiretroviral- naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda. AIDS Patient Care and STDS, 19(11), 760–768.PubMedCrossRef
go back to reference Blair, J. M., Hanson, D. L., Jones, J. L., & Dworkin, M. S. (2004). Trends in pregnancy rates among women with human immunodeficiency virus. Obstetrics and Gynecology, 103(4), 663–668.PubMed Blair, J. M., Hanson, D. L., Jones, J. L., & Dworkin, M. S. (2004). Trends in pregnancy rates among women with human immunodeficiency virus. Obstetrics and Gynecology, 103(4), 663–668.PubMed
go back to reference Braitstein, P., Brinkhof, M. W., Dabis, F., Schechter, M., Boulle, A., Miotti, P., Wood, R., Laurent, C., Sprinz, E., Seyler, C., Bangsberg, D., Balestre, E., Sterne, J. A., May, M., & Egger, M. (2006). Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: Comparison between low-income and high-income countries. The Lancet, 367(9513), 817–824.CrossRef Braitstein, P., Brinkhof, M. W., Dabis, F., Schechter, M., Boulle, A., Miotti, P., Wood, R., Laurent, C., Sprinz, E., Seyler, C., Bangsberg, D., Balestre, E., Sterne, J. A., May, M., & Egger, M. (2006). Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: Comparison between low-income and high-income countries. The Lancet, 367(9513), 817–824.CrossRef
go back to reference Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., Coutinho, A., Liechty, C., Madraa, E., Rutherford, G., & Mermin, J. (2006). Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS, 20(1), 85–92.PubMedCrossRef Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., Coutinho, A., Liechty, C., Madraa, E., Rutherford, G., & Mermin, J. (2006). Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS, 20(1), 85–92.PubMedCrossRef
go back to reference Dukers, N. H., Goudsmit, J., de Wit, J. B., Prins, M., Weverling, G. J., & Coutinho, R. A. (2001). Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS, 15(3), 369–378.PubMedCrossRef Dukers, N. H., Goudsmit, J., de Wit, J. B., Prins, M., Weverling, G. J., & Coutinho, R. A. (2001). Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS, 15(3), 369–378.PubMedCrossRef
go back to reference 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. The Lancet, 351(9096), 98–103.CrossRef 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. The Lancet, 351(9096), 98–103.CrossRef
go back to reference Homsy, J., Bennell, R., King, R., & Mermin, J. (2006). Determinants of Pregnancy Among Women Receiving HAART in Rural Uganda, Abstract 98. Paper presented at the PEPFAR Annual Meeting, 2006 HIV/AIDS Implementer’s Meeting. Durban, South Africa. June 12–15. Homsy, J., Bennell, R., King, R., & Mermin, J. (2006). Determinants of Pregnancy Among Women Receiving HAART in Rural Uganda, Abstract 98. Paper presented at the PEPFAR Annual Meeting, 2006 HIV/AIDS Implementer’s Meeting. Durban, South Africa. June 12–15.
go back to reference Kaida, A., Andia, I., Maier, M., Strathdee, S. A., Bangsberg, D. R., Spiegel, J., Bastos, F. I., Gray, G., & Hogg, R. (2006). The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa. Current HIV/AIDS Reports, 3(4), 187–194.PubMedCrossRef Kaida, A., Andia, I., Maier, M., Strathdee, S. A., Bangsberg, D. R., Spiegel, J., Bastos, F. I., Gray, G., & Hogg, R. (2006). The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa. Current HIV/AIDS Reports, 3(4), 187–194.PubMedCrossRef
go back to reference Katz, M. H., Schwarcz, S. K., Kellogg, T. A., Klausner, J. D., Dilley, J. W., Gibson, S., & McFarland, W. (2002). Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. American Journal of Public Health, 92(3), 388–394.PubMedCrossRef Katz, M. H., Schwarcz, S. K., Kellogg, T. A., Klausner, J. D., Dilley, J. W., Gibson, S., & McFarland, W. (2002). Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. American Journal of Public Health, 92(3), 388–394.PubMedCrossRef
go back to reference Kelly, J. A., Hoffman, R. G., Rompa, D., & Gray, M. (1998). Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex. AIDS, 12(10), F91–F95.PubMedCrossRef Kelly, J. A., Hoffman, R. G., Rompa, D., & Gray, M. (1998). Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex. AIDS, 12(10), F91–F95.PubMedCrossRef
go back to reference Lewis, J. J., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-Saharan Africa. AIDS, 18(Suppl 2), S35–S43.PubMedCrossRef Lewis, J. J., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-Saharan Africa. AIDS, 18(Suppl 2), S35–S43.PubMedCrossRef
go back to reference Massad, L. S., Springer, G., Jacobson, L., Watts, H., Anastos, K., Korn, A., Cejtin, H., Stek, A., Young, M., Schmidt, J., & Minkoff, H. (2004). Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV. AIDS, 18(2), 281–286.PubMedCrossRef Massad, L. S., Springer, G., Jacobson, L., Watts, H., Anastos, K., Korn, A., Cejtin, H., Stek, A., Young, M., Schmidt, J., & Minkoff, H. (2004). Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV. AIDS, 18(2), 281–286.PubMedCrossRef
go back to reference Mermin, J., Ekwaru, J. P., Liechty, C. A., Were, W., Downing, R., Ransom, R., Weidle, P., Lule, J., Coutinho, A., & Solberg, P. (2006). Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1–infected adults in Uganda: A prospective cohort study. The Lancet, 367(9518), 1256–1261.CrossRef Mermin, J., Ekwaru, J. P., Liechty, C. A., Were, W., Downing, R., Ransom, R., Weidle, P., Lule, J., Coutinho, A., & Solberg, P. (2006). Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1–infected adults in Uganda: A prospective cohort study. The Lancet, 367(9518), 1256–1261.CrossRef
go back to reference Miller, M., Meyer, L., Boufassa, F., Persoz, A., Sarr, A., Robain, M., & Spira, A. (2000). Sexual behavior changes and protease inhibitor therapy. SEROCO Study Group. AIDS, 14(4), F33–F39.PubMedCrossRef Miller, M., Meyer, L., Boufassa, F., Persoz, A., Sarr, A., Robain, M., & Spira, A. (2000). Sexual behavior changes and protease inhibitor therapy. SEROCO Study Group. AIDS, 14(4), F33–F39.PubMedCrossRef
go back to reference Moatti, J. P., Prudhomme, J., Traore, D. C., Juillet-Amari, A., Akribi, H. A., & Msellati, P. (2003). Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS, 17(Suppl 3), S69–S77.PubMedCrossRef Moatti, J. P., Prudhomme, J., Traore, D. C., Juillet-Amari, A., Akribi, H. A., & Msellati, P. (2003). Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS, 17(Suppl 3), S69–S77.PubMedCrossRef
go back to reference Mohohlo, M., Khosa, T., Mohapi L, & Gray, G. (2006). Pregnancy-Related Events in an Antiretroviral Treatment Program, Abstract 113. Paper presented at the PEPFAR Annual Meeting, 2006 HIV/AIDS Implementer’s Meeting, Durban, South Africa. June 12–15. Mohohlo, M., Khosa, T., Mohapi L, & Gray, G. (2006). Pregnancy-Related Events in an Antiretroviral Treatment Program, Abstract 113. Paper presented at the PEPFAR Annual Meeting, 2006 HIV/AIDS Implementer’s Meeting, Durban, South Africa. June 12–15.
go back to reference Panozzo, L., Battegay, M., Friedl, A., & Vernazza, P. L. (2003). High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner-two challenging issues. Swiss Medical Weekly, 133(7–8), 124–127.PubMed Panozzo, L., Battegay, M., Friedl, A., & Vernazza, P. L. (2003). High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner-two challenging issues. Swiss Medical Weekly, 133(7–8), 124–127.PubMed
go back to reference Ross, A., Van der Paal, L., Lubega, R., Mayanja, B. N., Shafer, L. A., & Whitworth, J. (2004). HIV-1 disease progression and fertility: The incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS, 18(5), 799–804.PubMedCrossRef Ross, A., Van der Paal, L., Lubega, R., Mayanja, B. N., Shafer, L. A., & Whitworth, J. (2004). HIV-1 disease progression and fertility: The incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS, 18(5), 799–804.PubMedCrossRef
go back to reference Scheer, S., Chu, P. L., Klausner, J. D., Katz, M. H., & Schwarcz, S. K. (2001). Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. The Lancet, 357(9254), 432–435.CrossRef Scheer, S., Chu, P. L., Klausner, J. D., Katz, M. H., & Schwarcz, S. K. (2001). Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. The Lancet, 357(9254), 432–435.CrossRef
go back to reference United Nations. (1997). World fertility patterns 1997 Africa. New York. United Nations. (1997). World fertility patterns 1997 Africa. New York.
go back to reference United Nations. (2005). Uganda Country Profile. New York. United Nations. (2005). Uganda Country Profile. New York.
go back to reference UNAIDS. (2006). 2006 Report on the global AIDS epidemic. New York. UNAIDS. (2006). 2006 Report on the global AIDS epidemic. New York.
go back to reference WHO. (2005). Core Health Indicators. Geneva. WHO. (2005). Core Health Indicators. Geneva.
go back to reference WHO. (2006a). Core Health Indicators. Geneva. WHO. (2006a). Core Health Indicators. Geneva.
go back to reference WHO. (2006b). WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Retrieved March 9, 2007, from WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva. WHO. (2006b). WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Retrieved March 9, 2007, from WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva.
go back to reference Wolf, K., Young, J., Rickenbach, M., Vernazza, P., Flepp, M., Furrer, H., Bernasconi, E., Hirschel, B., Telenti, A., Weber, R., & Bucher, H. C. (2003). Prevalence of unsafe sexual behavior among HIV-infected individuals: The Swiss HIV Cohort Study. Journal of Acquired Immune Deficiency Syndromes, 33(4), 494–499.PubMed Wolf, K., Young, J., Rickenbach, M., Vernazza, P., Flepp, M., Furrer, H., Bernasconi, E., Hirschel, B., Telenti, A., Weber, R., & Bucher, H. C. (2003). Prevalence of unsafe sexual behavior among HIV-infected individuals: The Swiss HIV Cohort Study. Journal of Acquired Immune Deficiency Syndromes, 33(4), 494–499.PubMed
go back to reference Zaba, B., & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS, 12(Suppl 1), S41–S50.PubMed Zaba, B., & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS, 12(Suppl 1), S41–S50.PubMed
Metadata
Title
Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, among HIV+ Women in an Early HIV Treatment Program in Rural Uganda
Authors
Marissa Maier
Irene Andia
Nneka Emenyonu
David Guzman
Angela Kaida
Larry Pepper
Robert Hogg
David R. Bangsberg
Publication date
01-06-2009
Publisher
Springer US
Published in
AIDS and Behavior / Issue Special Issue 1/2009
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-008-9371-7

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