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AIDS and Behavior

, Volume 13, Supplement 1, pp 28–37 | Cite as

Antiretroviral Therapy is Associated with Increased Fertility Desire, but not Pregnancy or Live Birth, among HIV+ Women in an Early HIV Treatment Program in Rural Uganda

  • Marissa MaierEmail author
  • Irene Andia
  • Nneka Emenyonu
  • David Guzman
  • Angela Kaida
  • Larry Pepper
  • Robert Hogg
  • David R. Bangsberg
Original Paper

Abstract

To assess the association between antiretroviral therapy (ART) and fertility history and desire among HIV-positive Ugandan women, we conducted a cross-sectional study among HIV-positive Ugandan women aged 18–50 years who attended an HIV clinic at Mbarara University in western Uganda between November 1, 2005 and June 6, 2006. Of 538 women approached, 501 were enrolled. ART use was associated with increased odds of fertility desire (AOR 2.99, 95% CI 1.38–6.28), and decreased odds of pregnancy (AOR 0.56, 95% CI 0.33–0.95) and live birth (AOR 0.30, 95% CI 0.13–0.66). ART was associated with an increase in fertility desire, but was not associated with an increase in fertility. Additional studies will be needed to determine if this greater fertility desire among ART-treated women leads to an increase in fertility as ART use expands.

Keywords

Uganda Fertility HIV/AIDS Fertility desires Antiretroviral therapy 

Notes

Acknowledgements

Funding was provided from The Doris Duke Charitable Foundation, NIMH 54907, and NIAAA K-24 015287. The authors thank the Mbarara Hospital ISS clinic and Mbarara Hospital for their administrative support, as well as Drs. Deborah Cohan and John Tercier for their critical review of the manuscript. Finally, the authors thank the study participants for their time and willingness to share personal information with the study team.

References

  1. Badri, M., Lawn, S. D., & Wood, R. (2006). Short-term risk of AIDS or death in people infected with HIV-1 before antiretroviral therapy in South Africa: A longitudinal study. The Lancet, 368(9543), 1254–1259.CrossRefGoogle Scholar
  2. Badri, M., Wilson, D., & Wood, R. (2002). Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: A cohort study. The Lancet, 359(9323), 2059–2064.CrossRefGoogle Scholar
  3. Bateganya, M., Colfax, G., Shafer, L. A., Kityo, C., Mugyenyi, P., Serwadda, D., Mayanja, H., & Bangsberg, D. (2005). Antiretroviral therapy and sexual behavior: A comparative study between antiretroviral- naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda. AIDS Patient Care and STDS, 19(11), 760–768.PubMedCrossRefGoogle Scholar
  4. Blair, J. M., Hanson, D. L., Jones, J. L., & Dworkin, M. S. (2004). Trends in pregnancy rates among women with human immunodeficiency virus. Obstetrics and Gynecology, 103(4), 663–668.PubMedGoogle Scholar
  5. Braitstein, P., Brinkhof, M. W., Dabis, F., Schechter, M., Boulle, A., Miotti, P., Wood, R., Laurent, C., Sprinz, E., Seyler, C., Bangsberg, D., Balestre, E., Sterne, J. A., May, M., & Egger, M. (2006). Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: Comparison between low-income and high-income countries. The Lancet, 367(9513), 817–824.CrossRefGoogle Scholar
  6. Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., Coutinho, A., Liechty, C., Madraa, E., Rutherford, G., & Mermin, J. (2006). Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS, 20(1), 85–92.PubMedCrossRefGoogle Scholar
  7. Dukers, N. H., Goudsmit, J., de Wit, J. B., Prins, M., Weverling, G. J., & Coutinho, R. A. (2001). Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS, 15(3), 369–378.PubMedCrossRefGoogle Scholar
  8. Gray, R. H., Wawer, M. J., Serwadda, D., Sewankambo, N., Li, C., Wabwire-Mangen, F., Paxton, L., Kiwanuka, N., Kigozi, G., Konde-Lule, J., Quinn, T. C., Gaydos, C. A., & McNairn, D. (1998). Population-based study of fertility in women with HIV-1 infection in Uganda. The Lancet, 351(9096), 98–103.CrossRefGoogle Scholar
  9. Homsy, J., Bennell, R., King, R., & Mermin, J. (2006). Determinants of Pregnancy Among Women Receiving HAART in Rural Uganda, Abstract 98. Paper presented at the PEPFAR Annual Meeting, 2006 HIV/AIDS Implementer’s Meeting. Durban, South Africa. June 12–15.Google Scholar
  10. Kaida, A., Andia, I., Maier, M., Strathdee, S. A., Bangsberg, D. R., Spiegel, J., Bastos, F. I., Gray, G., & Hogg, R. (2006). The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa. Current HIV/AIDS Reports, 3(4), 187–194.PubMedCrossRefGoogle Scholar
  11. Katz, M. H., Schwarcz, S. K., Kellogg, T. A., Klausner, J. D., Dilley, J. W., Gibson, S., & McFarland, W. (2002). Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco. American Journal of Public Health, 92(3), 388–394.PubMedCrossRefGoogle Scholar
  12. Kelly, J. A., Hoffman, R. G., Rompa, D., & Gray, M. (1998). Protease inhibitor combination therapies and perceptions of gay men regarding AIDS severity and the need to maintain safer sex. AIDS, 12(10), F91–F95.PubMedCrossRefGoogle Scholar
  13. Lewis, J. J., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-Saharan Africa. AIDS, 18(Suppl 2), S35–S43.PubMedCrossRefGoogle Scholar
  14. Massad, L. S., Springer, G., Jacobson, L., Watts, H., Anastos, K., Korn, A., Cejtin, H., Stek, A., Young, M., Schmidt, J., & Minkoff, H. (2004). Pregnancy rates and predictors of conception, miscarriage and abortion in US women with HIV. AIDS, 18(2), 281–286.PubMedCrossRefGoogle Scholar
  15. Mermin, J., Ekwaru, J. P., Liechty, C. A., Were, W., Downing, R., Ransom, R., Weidle, P., Lule, J., Coutinho, A., & Solberg, P. (2006). Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1–infected adults in Uganda: A prospective cohort study. The Lancet, 367(9518), 1256–1261.CrossRefGoogle Scholar
  16. Miller, M., Meyer, L., Boufassa, F., Persoz, A., Sarr, A., Robain, M., & Spira, A. (2000). Sexual behavior changes and protease inhibitor therapy. SEROCO Study Group. AIDS, 14(4), F33–F39.PubMedCrossRefGoogle Scholar
  17. Moatti, J. P., Prudhomme, J., Traore, D. C., Juillet-Amari, A., Akribi, H. A., & Msellati, P. (2003). Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS, 17(Suppl 3), S69–S77.PubMedCrossRefGoogle Scholar
  18. Mohohlo, M., Khosa, T., Mohapi L, & Gray, G. (2006). Pregnancy-Related Events in an Antiretroviral Treatment Program, Abstract 113. Paper presented at the PEPFAR Annual Meeting, 2006 HIV/AIDS Implementer’s Meeting, Durban, South Africa. June 12–15.Google Scholar
  19. Panozzo, L., Battegay, M., Friedl, A., & Vernazza, P. L. (2003). High risk behaviour and fertility desires among heterosexual HIV-positive patients with a serodiscordant partner-two challenging issues. Swiss Medical Weekly, 133(7–8), 124–127.PubMedGoogle Scholar
  20. Ross, A., Van der Paal, L., Lubega, R., Mayanja, B. N., Shafer, L. A., & Whitworth, J. (2004). HIV-1 disease progression and fertility: The incidence of recognized pregnancy and pregnancy outcome in Uganda. AIDS, 18(5), 799–804.PubMedCrossRefGoogle Scholar
  21. Scheer, S., Chu, P. L., Klausner, J. D., Katz, M. H., & Schwarcz, S. K. (2001). Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. The Lancet, 357(9254), 432–435.CrossRefGoogle Scholar
  22. United Nations. (1997). World fertility patterns 1997 Africa. New York.Google Scholar
  23. United Nations. (2005). Uganda Country Profile. New York.Google Scholar
  24. UNAIDS. (2006). 2006 Report on the global AIDS epidemic. New York.Google Scholar
  25. WHO. (2005). Core Health Indicators. Geneva.Google Scholar
  26. WHO. (2006a). Core Health Indicators. Geneva.Google Scholar
  27. WHO. (2006b). WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Retrieved March 9, 2007, from WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Geneva.Google Scholar
  28. Wolf, K., Young, J., Rickenbach, M., Vernazza, P., Flepp, M., Furrer, H., Bernasconi, E., Hirschel, B., Telenti, A., Weber, R., & Bucher, H. C. (2003). Prevalence of unsafe sexual behavior among HIV-infected individuals: The Swiss HIV Cohort Study. Journal of Acquired Immune Deficiency Syndromes, 33(4), 494–499.PubMedGoogle Scholar
  29. Zaba, B., & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS, 12(Suppl 1), S41–S50.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Marissa Maier
    • 1
    Email author
  • Irene Andia
    • 3
  • Nneka Emenyonu
    • 2
  • David Guzman
    • 2
  • Angela Kaida
    • 4
    • 5
  • Larry Pepper
    • 3
  • Robert Hogg
    • 5
    • 6
  • David R. Bangsberg
    • 2
  1. 1.Department of Internal MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.Department of Internal MedicineUniversity of California, San Francisco (UCSF)San FranciscoUSA
  3. 3.Department of Internal MedicineMbarara University of Science and TechnologyMbararaUganda
  4. 4.Department of Healthcare and Epidemiology, Faculty of MedicineUniversity of British Columbia (UBC)VancouverCanada
  5. 5.BC Centre for Excellence in HIV/AIDSVancouverCanada
  6. 6.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada

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