Effect of pregnancy on HIV disease progression and survival among women in rural Uganda.
OBJECTIVE
To investigate the effect of pregnancy on HIV disease progression and survival among HIV-infected women in rural Uganda, prior to the introduction of anti-retroviral therapy (ART).


METHODS
From a clinical cohort established in 1990, we selected records from HIV-infected women of reproductive age. We conducted two analyses: (1) all HIV-infected cases contributing to analysis of CD4 decline, using a linear regression model with random intercepts and slopes; (b) incident cases with known date of seroconversion contributed to analyses of median time to CD4 <200 cells/microl, AIDS and death.


RESULTS
A total of 139 women were included in the analysis of CD4 decline. Women who subsequently became pregnant had higher CD4 counts at enrolment and had a slower CD4 decline than those who did not become pregnant. In women who became pregnant, CD4 decline was faster after pregnancy than before (P < 0.0001). The survival analyses showed no significant differences between women who became pregnant and those who did not with respect to median time to CD4 count <200, AIDS or death.


CONCLUSIONS
The initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy. Women should be informed about the potential negative effect of pregnancy on their immunological status and should be offered contraception. In resource-limited settings, women determined to become pregnant should be given priority for ART if eligible.
Lieve
Van der Paal
Vd
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. lieve.vanderpaal@mrcuganda.org
Shafer
Leigh Anne
LA
Mayanja
Billy N
BN
Whitworth
Jimmy A G
JA
Grosskurth
Heiner
H
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000401:mortality*; D012044:Regression Analysis; D012307:Risk Factors; D012423:Rural Health; D016019:Survival Analysis; D014454:Uganda / Q000453:epidemiology