[Impaired fertility in women infected with HIV-1. Implications for sentinel serosurveillance].
BACKGROUND
Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance.


METHODS
In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent.


RESULTS
Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women.


CONCLUSIONS
Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.
Yaro
S
S
Centre MURAZ, Organisation de Coordination et de Coopération pour la lutte contre les Grandes Endémies (OCCGE), 01 B.P. 153 Bobo-Dioulasso 01, Burkina Faso.
Meda
N
N
Desgrées Du Loû
A
A
Sombie
I
I
Cartoux
M
M
Tiendrebeogo
S
S
Ouangre
A
A
Dao
B
B
Nacro
B
B
Kpozehouen
A
A
Nebie
Y
Y
Fao
P
P
Ky-Zerbo
O
O
Van De Perre
P
P
Mandelbrot
L
L
Dabis
F
F
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015982:Bias; D002050:Burkina Faso / Q000453:epidemiology; D016022:Case-Control Studies; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018023:HIV Seronegativity; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000821:virology*; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D014504:Urban Health / Q000706:statistics & numerical data