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. 2020 Jun 11;221(12):1953-1962.
doi: 10.1093/infdis/jiz362.

Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa

Leigh F Johnson  1 , Themba Mutemaringa  1   2 , Alexa Heekes  1   2 , Andrew Boulle  1   2
Affiliations

Effect of HIV Infection and Antiretroviral Treatment on Pregnancy Rates in the Western Cape Province of South Africa

Leigh F Johnson et al. J Infect Dis. .

Abstract

Background: Previous studies suggest that untreated human immunodeficiency virus (HIV) infection is associated with a reduced incidence of pregnancy, but studies of the effect of antiretroviral treatment (ART) on pregnancy incidence have been inconsistent.

Methods: Routine data from health services in the Western Cape province of South Africa were linked to identify pregnancies during 2007-2017 and maternal HIV records. The time from the first (index) pregnancy outcome date to the next pregnancy was modeled using Cox proportional hazards models.

Results: During 2007-2017, 1 042 647 pregnancies were recorded. In all age groups, pregnancy incidence rates were highest in women who had started ART, lower in HIV-negative women, and lowest in ART-naive HIV-positive women. In multivariable analysis, after controlling for the most recent CD4+ T-cell count, pregnancy incidence rates in HIV-positive women receiving ART were higher than those in untreated HIV-positive women (adjusted hazard ratio, 1.63; 95% confidence interval, 1.59-1.67) and those in HIV-negative women.

Conclusion: Among women who have recently been pregnant, receipt of ART is associated with high rates of second pregnancy. Better integration of family planning into HIV care services is needed.

Keywords: HIV/AIDS; antiretroviral therapy; pregnancy incidence; sub-Saharan Africa.

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Figures

Figure 1.
Figure 1.
Live births in the Western Cape province. Recorded numbers of live births are lower than those estimated by the Thembisa model because (1) births in the private sector are not included, and (2) not all pregnancies in the public sector are recorded (particularly in the earlier years). Possible live births are recorded pregnancies for which the outcome is not certain. P, pregnancy confidence score.
Figure 2.
Figure 2.
Pregnancy incidence rates (per 100 woman-years), by human immunodeficiency virus (HIV) status and age at index pregnancy. A, Follow-up is censored at the earlier of 31 March 2017 or the date of second pregnancy conception. B, Follow-up is censored 730 days after the last patient contact with the health service (if this occurs before the original censoring data) or, in the case of HIV-positive women, 270 days before last HIV-related laboratory test (if this occurs >2 years after the last contact date). ART, antiretroviral therapy.
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