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.