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HIV-1 Disease Progression and Fertility in Dar es Salaam, Tanzania

Sedgh, Gilda ScD*; Larsen, Ulla PhD; Spiegelman, Donna ScD*‡; Msamanga, Gernard DrPh§; Fawzi, Wafaie W DrPh*∥

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2005 - Volume 39 - Issue 4 - p 439-445
doi: 10.1097/01.qai.0000148529.58963.83
Epidemiology and Social Science

Objectives: To examine the association of HIV-1 disease progression with pregnancy and live birth incidence in a cohort of HIV-1-positive women in Dar es Salaam, Tanzania, and to identify other determinants of fertility in this population.

Design and Methods: Clinic-based prospective cohort study of HIV-1-infected women followed for up to 6 years and Cox proportional hazards models.

Results: The multivariate pregnancy rate ratio (RR) comparing women at clinical stage II with women at stage I was 0.56 (95% confidence interval [CI]: 0.39, 0.82), and the pregnancy RR for women at stage III or IV compared with women at stage I was 0.24 (95% CI: 0.16, 0.36), controlling for independent predictors of pregnancy incidence. Pregnancy rates were lower among older women, unmarried women, women who had revealed their HIV status to someone, and women who had living children from their most recent pregnancy. The association of HIV-1 clinical progression with a decline in pregnancy incidence was not explained by weight loss, menstrual dysfunction, or nutritional status.

Conclusion: Pregnancy and live birth rates decline dramatically with progression of HIV-1 disease. This decline is not explained by observed social, behavioral, or biologic factors.

From the *Department of Epidemiology, Harvard School of Public Health, Boston, MA; †Department of Population and International Health, Harvard School of Public Health, Boston, MA; ‡Department of Biostatistics, Harvard School of Public Health, Boston, MA; §Department of Community Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; and ∥Department of Nutrition, Harvard School of Public Health, Boston, MA.

Received for publication September 25, 2003; accepted October 12, 2004.

Supported by National Institute of Child Health and Human Development (NICHD R01 32257), the Fogarty International Center (NIH D43 TW00004), and the Department of Epidemiology, Harvard School of Public Health.

Correspondence: Gilda Sedgh, 212 Idris Road, Merion Station, PA 19066 (e-mail:

Reprints: Wafaie W. Fawzi, Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Boston MA (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.