title: Population-based study of fertility in women with HIV-1 infection in Uganda.
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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Population Dynamics, School of Hygiene and Public Health, Johns Hopkins University, Baltimore MD 21205, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Gray
authors.forename: M J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: D
authors.initials: D
authors.lastname: Serwadda
authors.forename: N
authors.initials: N
authors.lastname: Sewankambo
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.forename: F
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: L
authors.initials: L
authors.lastname: Paxton
authors.forename: N
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: G
authors.initials: G
authors.lastname: Kigozi
authors.forename: J
authors.initials: J
authors.lastname: Konde-Lule
authors.forename: T C
authors.initials: TC
authors.lastname: Quinn
authors.forename: C A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: D
authors.initials: D
authors.lastname: McNairn
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D018873:Pregnancy Rate; D015995:Prevalence; D011446:Prospective Studies; D012424:Rural Population; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D014454:Uganda / Q000453:epidemiology