title: HIV-1 disease progression and fertility: the incidence of recognized pregnancy and pregnancy outcome in Uganda.
abstract: OBJECTIVE
  To estimate the association between HIV disease progression and the incidence of recognized pregnancy; to estimate the risk of subsequent fetal loss.
  
  
  METHODS
  A total of 191 women (92 HIV seropositive and 99 HIV seronegative at enrolment) aged 15-49 years in an HIV clinical cohort were invited to attend routine clinic visits every 3 months. Information on HIV progression collected at the visit was related to whether there was a pregnancy beginning in the following 3 months. Visits were excluded where the woman was already pregnant, lactating, using modern contraceptives or if there was inadequate follow-up.
  
  
  RESULTS
  There were 2524 eligible visits and 216 recognized pregnancies. The reported frequency of sexual intercourse diminished with advancing HIV disease. The adjusted odds ratio (OR) for pregnancy when the woman was in WHO stage 1 compared with HIV seronegatives was 0.58 [95% confidence interval (CI), 0.36-0.93]; stage 2, 0.47 (95% CI, 0.25-0.91); stage 3, 0.43 (95% CI, 0.25-0.74); and stage 4, (AIDS) 0.14 (95% CI, 0.02-1.09). The findings were similar for CD4 cell count, time from seroconversion and time before AIDS. There was an increase in fetal loss from the early stages of HIV infection (adjusted OR for stage 1, 5.38; 95% CI, 1.57-18.44), there were very few recognized pregnancies in the advanced stages.
  
  
  CONCLUSIONS
  Fertility is reduced from the earliest asymptomatic stage of HIV infection resulting from both a reduced incidence of recognized pregnancy and increased fetal loss. The greatest reduction in fertility was observed following progression to AIDS when there was a very low incidence of recognized pregnancies.
authors.affiliation: KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230, Kilifi, Kenya. amanda.ross@unibas.ch
authors.forename: Amanda
authors.initials: A
authors.lastname: Ross
authors.forename: Lieve
authors.initials: L
authors.lastname: Van der Paal
authors.forename: Rosemary
authors.initials: R
authors.lastname: Lubega
authors.forename: Billy N
authors.initials: BN
authors.lastname: Mayanja
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Shafer
authors.forename: Jimmy
authors.initials: J
authors.lastname: Whitworth
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D018450:Disease Progression; D005260:Female; D005298:Fertility; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012044:Regression Analysis; D014454:Uganda / Q000453:epidemiology