title: Associations between HIV Antiretroviral Therapy and the Prevalence and Incidence of Pregnancy in Rakai, Uganda.
abstract: Background. Use of antiretroviral therapy (ART) may be associated with higher pregnancy rates. Methods. The prevalence and incidence of pregnancy was assessed in 712 HIV+ pre-ART women of reproductive age (WRA) (15-45) and 244 HIV+ WRA initiating ART. Prevalence rate ratios (PRR), incidence rate ratios (IRR), and 95% confidence interval (CI) were assessed. Results. The incidence of pregnancy was 13.1/100 py among women in pre-ART care compared to 24.6/100 py among women on ART (IRR = 0.54; 95% CI 0.37, 0.81, p < 0.0017). The prevalence of pregnancy at ART initiation was 12.0% with CD4 counts 100-250 compared with 3.2% with CD4 <100 (PRR = 3.24, CI 1.51-6.93), and the incidence of pregnancy while on ART was highest in women with a good immunologic response. Desire for more children was a very important factor in fertility. Conclusion. ART was associated with increased pregnancy rates in HIV+ women, particularly those with higher CD4 counts and good immunologic response to therapy, suggesting a need to strengthen reproductive health services for both women and their partners that could address their fertility decisions/intentions particularly after ART initiation.
authors.affiliation: School of Public Health, Makerere University, 7072 Kampala, Uganda.
authors.forename: Fredrick E
authors.initials: FE
authors.lastname: Makumbi
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Anthony
authors.initials: A
authors.lastname: Ndyanabo
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.forename: David
authors.initials: D
authors.lastname: Serwada
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: Ron
authors.initials: R
authors.lastname: Gray