title: Effect of subsequent pregnancies on HIV disease progression among women in the Mulago Hospital MTCT-Plus program in Uganda.
abstract: OBJECTIVE
  To investigate the effect of subsequent pregnancies on HIV disease progression among HIV-infected women at Mulago Hospital, Uganda.
  
  
  METHODS
  In a retrospective cohort study, data were analyzed from women enrolled in the Mother-To-Child Transmission Plus program from March 2003 to December 2011. The CD4 cell count, the development of new AIDS-defining opportunistic infections, and the AIDS-related mortality were compared between women with and without subsequent pregnancies.
  
  
  RESULTS
  Overall, 409 women were enrolled and 195 (47.7%) had subsequent pregnancies. Antiretroviral therapy (ART) was initiated in 143 (73.3%) women with and 155 (72.4%) women without subsequent pregnancies. Kaplan-Meier analysis for women receiving ART showed no differences between women with and without subsequent pregnancies in the median times to clinical failure (62.7 vs 64.7 months; P=0.31), immunological failure (68.8 vs 75.5 months; P=0.10), and death (68.8 vs 75.5 months; P=0.53). In a Cox regression analysis, subsequent pregnancies were not associated with immunological failure during follow-up (adjusted hazard ratio 1.13, 95% confidence interval 0.06-2.09).
  
  
  CONCLUSIONS
  Subsequent pregnancies could have no detrimental effect on HIV disease progression among HIV-infected women whose treatment is well managed.
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Dinah
authors.initials: D
authors.lastname: Amongin
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Annettee
authors.initials: A
authors.lastname: Nakimuli
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Busingye
authors.affiliation: Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
authors.forename: Mike
authors.initials: M
authors.lastname: Mubiru
authors.affiliation: Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda; Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda. Electronic address: tmutyaba@yahoo.com.
authors.forename: Twaha
authors.initials: T
authors.lastname: Mutyaba
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001424:Bacterial Infections / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents
keywords: HIV progression; Maternal mortality; Mulago; Subsequent pregnancies; Uganda; Women