title: Incident pregnancy and pregnancy outcomes among HIV-infected women in Uganda and Zimbabwe.
abstract: OBJECTIVE
  To describe pregnancy outcomes among HIV-infected women and examine factors associated with live birth among those receiving and not receiving combination antiretroviral therapy (cART).
  
  
  METHODS
  The present analysis included women with HIV from Uganda and Zimbabwe who participated in a prospective cohort study during 2001-2009. Incident pregnancies and pregnancy outcomes were recorded quarterly. The Kaplan-Meier method was used to estimate incident pregnancy probabilities; factors associated with live birth were evaluated by Poisson regression with generalized estimating equations.
  
  
  RESULTS
  Among 306 HIV-infected women, there were 160 incident pregnancies (10.1 per 100 women-years). The pregnancy rate was higher among cART-naïve women than among those receiving cART (10.7 vs 5.5 per 100 women-years; P=0.047), and it was higher in Uganda than in Zimbabwe (14.4 vs 7.7 per 100 women-years; P<0.001). Significant associations were noted between a live birth and prenatal care (relative risk 3.9; 95% confidence interval 2.2-6.9) and illness during pregnancy (relative risk 0.8; 95% confidence interval 0.7-1.0).
  
  
  CONCLUSIONS
  Women not receiving cART have higher pregnancy rates than do those receiving cART, but cART use might not affect the risk of adverse pregnancy outcomes. Timely prenatal care and monitoring of illnesses during pregnancy should be incorporated into treatment services for HIV-infected women.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: klancaster@unc.edu.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Lancaster
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kwok
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Rinaldi
authors.affiliation: Faculty of Medicine, Makerere University, Kampala, Uganda.
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.affiliation: Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Tulani
authors.initials: T
authors.lastname: Magwali
authors.affiliation: Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Prisca
authors.initials: P
authors.lastname: Nyamapfeni
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011295:Prenatal Care / Q000379:methods; D011446:Prospective Studies; D014454:Uganda; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; HIV; Pregnancy outcomes; Uganda; Zimbabwe