title: Trends of and factors associated with live-birth and abortion rates among HIV-positive and HIV-negative women.
abstract: BACKGROUND
  Little is known about fertility choices and pregnancy outcome rates among HIV-infected women in the current combination antiretroviral treatment era.
  
  
  OBJECTIVE
  We sought to describe trends and factors associated with live-birth and abortion rates among HIV-positive and high-risk HIV-negative women enrolled in the Women's Interagency HIV Study in the United States.
  
  
  METHODS
  We analyzed longitudinal data collected from Oct. 1, 1994, through Sept. 30, 2012, through the Women's Interagency HIV Study. Age-adjusted rates per 100 person-years live births and induced abortions were calculated by HIV serostatus over 4 time periods. Poisson mixed effects models containing variables associated with live births and abortions in bivariable analyses (P < .05) generated adjusted incidence rate ratios and 95% confidence intervals.
  
  
  RESULTS
  There were 1356 pregnancies among 2414 women. Among HIV-positive women, age-adjusted rates of live birth increased from 1994 through 1997 to 2006 through 2012 (2.85-7.27/100 person-years, P trend < .0001). Age-adjusted rates of abortion in HIV-positive women remained stable over these time periods (4.03-4.29/100 person-years, P trend = .09). Significantly lower live-birth rates occurred among HIV-positive compared to HIV-negative women in 1994 through 1997 and 1997 through 2001, however rates were similar during 2002 through 2005 and 2006 through 2012. Higher CD4+T cells/mm3(≥350 adjusted incidence rate ratio, 1.39 [95% CI 1.03-1.89] vs <350) were significantly associated with increased live-birth rates, while combination antiretroviral treatment use (adjusted incidence rate ratio, 1.35 [95% CI 0.99-1.83]) was marginally associated with increased live-birth rates. Younger age, having a prior abortion, condom use, and increased parity were associated with increased abortion rates among both HIV-positive and HIV-negative women. CD4+T-cell count, combination antiretroviral treatment use, and viral load were not associated with abortion rates.
  
  
  CONCLUSIONS
  Unlike earlier periods (pre-2001) when live-birth rates were lower among HIV-positive women, rates are now similar to HIV-negative women, potentially due to improved health status and combination antiretroviral treatment. Abortion rates remain unchanged, illuminating a need to improve contraceptive services.
authors.affiliation: Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA. Electronic address: lbhadda@emory.edu.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Haddad
authors.affiliation: Department of Epidemiology, Rollins School of Public Heath, Emory University, Atlanta, GA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Heath, Emory University, Atlanta, GA.
authors.forename: C Christina
authors.initials: CC
authors.lastname: Mehta
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Heath, Baltimore, MD.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rahangdale
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Mirjam-Colette
authors.initials: MC
authors.lastname: Kempf
authors.affiliation: Department of Preventative Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA.
authors.forename: Roksana
authors.initials: R
authors.lastname: Karim
authors.affiliation: Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Rodney
authors.initials: R
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.affiliation: Departments of Medicine, John H. Stroger Jr. Hospital of Cook County and Rush University, Chicago, IL.
authors.forename: Mardge
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Department of Medicine, Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington DC.
authors.forename: Seble
authors.initials: S
authors.lastname: Kassaye
authors.affiliation: Department of Obstetrics and Gynecology, University of California San Francisco School of Medicine, San Francisco, CA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohan
authors.affiliation: Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
authors.forename: Igho
authors.initials: I
authors.lastname: Ofotokun
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Cohn
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001723:Birth Rate; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D050498:Live Birth / Q000453:epidemiology*; D008137:Longitudinal Studies; D011247:Pregnancy; D011446:Prospective Studies; D012306:Risk; D055815:Young Adult
keywords: HIV; abortion; antiretroviral therapy; live birth; pregnancy