title: Incidence of pregnancy after antiretroviral therapy initiation and associated factors in 8 West African countries.
abstract: BACKGROUND
  This study aimed at estimating the incidence of pregnancy after antiretroviral therapy (ART) initiation in 8 West African countries over a 10-year period.
  
  
  METHODS
  A retrospective analysis was conducted within the international database of the IeDEA West Africa Collaboration. All HIV-infected women aged <50 years and starting ART for their own health between 1998 and 2011 were eligible. Pregnancy after ART initiation was the main outcome and was based on clinical reporting. Poisson regression analysis accounting for country heterogeneity was computed to estimate first pregnancy incidence post-ART and to identify its associated factors. Pregnancy incidence rate ratios were adjusted on country, baseline CD4 count and clinical stage, hemoglobin, age, first ART regimen, and calendar year.
  
  
  RESULTS
  Overall, 29,425 HIV-infected women aged 33 years in median (interquartile range, 28-38) contributed for 84,870 women-years of follow-up to this analysis. The crude incidence of first pregnancy (2304 events) was 2.9 per 100 women-years [95% confidence interval (CI): 2.7 to 3.0], the highest rate being reported among women aged 25-29 years: 4.7 per 100 women-years; 95% CI: 4.3 to 5.1. The overall Kaplan-Meier probability of pregnancy occurrence by the fourth year on ART was 10.9% (95% CI: 10.4 to 11.4) and as high as 28.4% (95% CI: 26.3 to 30.6) among women aged 20-29 years at ART initiation.
  
  
  CONCLUSIONS
  The rate of pregnancy occurrence after ART initiation among HIV-infected women living in the West Africa region was high. Family planning services tailored to procreation needs should be provided to all HIV-infected women initiating ART and health consequences carefully monitored in this part of the world.
authors.affiliation: *Université de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; †INSERM, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France; ‡Centre Médical de Suivi de Donneurs de Sang (CMSDS), Abidjan, Côte d'Ivoire; §University of Abuja Teaching Hospital (UATH), Abuja, Nigeria; ‖Hôpital de jour, CHU Souro Sanou, Bobo Dioulasso, Burkina-Faso; ¶Centre de Prise en Charge des Personnes vivant avec le VIH, CHNU, Cotonou, Benin; and #Département des sciences fondamentales et santé publique, faculté des sciences de la santé, université de Lomé, Lomé, Togo.
authors.forename: Juan
authors.initials: J
authors.lastname: Burgos-Soto
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.forename: Samuel
authors.initials: S
authors.lastname: Ajayi
authors.forename: Adrien
authors.initials: A
authors.lastname: Sawadogo
authors.forename: Marcel D
authors.initials: MD
authors.lastname: Zannou
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy / Q000706:statistics & numerical data*; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents