title: Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya.
abstract: OBJECTIVE
  A large proportion of new HIV infections in sub-Saharan Africa occur in stable HIV-discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour despite knowledge of discordant serostatus. Our objective was to compare HIV transmission between discordant couples who did and did not conceive during participation in a clinical trial.
  
  
  METHODS
  Five hundred and thirty-two HIV-discordant couples were followed for up to 2 years in Kisumu, Kenya as part of the Partners in Prevention HSV/HIV Transmission Study. Quarterly HIV-1 antibody and urine pregnancy test results were analysed.
  
  
  RESULTS
  Forty-one HIV-1 seroconversions occurred over 888 person-years of follow-up, resulting in an annual incidence of 4.6/100 person-years. Twenty seroconversions occurred among 186 HIV-1-uninfected individuals in partnerships in which pregnancy occurred (10.8% of HIV-1-negative partners in this group seroconverted), in comparison to 21 seroconversions among 353 uninfected individuals in partnerships in which pregnancy did not occur (5.9% of HIV-1-negative partners seroconverted), resulting in a relative risk of 1.8 [95% confidence interval (CI) 1.01-3.26; P<0.05].
  
  
  CONCLUSIONS
  Pregnancy was associated with an increased risk of HIV seroconversion in discordant couples. These data suggest that the intention to conceive among HIV discordant couples may be contributing to the epidemic.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA. sara.brubaker@ucsf.edu
authors.forename: S G
authors.initials: SG
authors.lastname: Brubaker
authors.forename: E A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: J
authors.initials: J
authors.lastname: Odoyo
authors.forename: J
authors.initials: J
authors.lastname: Achando
authors.forename: A
authors.initials: A
authors.lastname: Okumu
authors.forename: C R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012309:Risk-Taking; D012747:Sexual Partners