title: Reduced fertility among HIV-infected women associated with viral load in Rakai district, Uganda.
abstract: We assessed whether HIV-1 viral load affects the likelihood of live birth among HIV-positive women in a nested case-control study of HIV-positive women from a community cohort in Rakai District, Uganda. Cases were women who had a live birth (n = 270), and controls were sexually active women who did not use contraception and did not become pregnant during follow-up (n = 263). In women with a live birth and non-pregnant controls, median HIV viral loads were 4.12 log(10) copies/mL and 4.41 log(10) copies/mL, respectively (P = 0.001). A non-linear association was observed, and a segmented linear regression with spline knot at 4.5 log(10) copies/mL was fit. We observed a decline in the log (adjusted odds ratio [adj. OR])= -0.08 (95% confidence interval [CI]: -0.36, 0.20) between 3.0 and 4.49 log(10) viral load and -0.92 (95% CI: -1.21, -0.63) between 4.5 and 6.5 log(10) viral load. The two reductions differed significantly from one another (P < 0.001). Each increase in log(10) viral load after 4.5 log(10) resulted in an adj. OR of live birth which was 12% of the previous viral load category. Our data suggest that there may be considerable differences in the ability to produce a live birth among HIV-positive women with high viral loads.
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA. nguyen5@niehs.nih.gov
authors.forename: Ruby H N
authors.initials: RH
authors.lastname: Nguyen
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gange
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005298:Fertility / Q000502:physiology*; D015658:HIV Infections / Q000453:epidemiology / Q000503:physiopathology* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load