The effect of HIV diagnosis on reproductive experience. Study Group for the Medical Research Council Collaborative Study of Women with HIV.

OBJECTIVES

To compare rates of reproductive events before and after HIV diagnosis in a cohort of women with HIV infection, and to consider the impact of HIV diagnosis on the outcome of pregnancy.

DESIGN

Observational cohort study of 503 women recruited from 15 genitourinary medicine/HIV clinics in Britain and Ireland. The 503 women had 580 pregnancies before diagnosis of HIV infection and 202 after HIV diagnosis.

METHODS

Using date of birth, date of HIV diagnosis, the outcome of all lifetime pregnancies and date of each outcome, age-specific rates (per 100 women-years) of pregnancy, miscarriage, termination and live-birth were calculated before HIV diagnosis, and separately after HIV diagnosis. Rates after HIV diagnosis were age-standardized for comparison with rates before HIV diagnosis. Rates were also calculated separately by ethnic group and HIV transmission group.

RESULTS

In women aged 20-34 years, the age-adjusted live-birth rate fell by 44% from 10.2 [95% confidence interval (CI), 9.2-11.2] per 100 women-years before HIV diagnosis to 5.7 (95% CI, 4.3-7.1) after diagnosis. Most of the decline reflected an increase in termination rate from 3.5 (95% CI, 2.9-4.1) before HIV diagnosis to 6.3 (95% CI, 4.7-7.9) after diagnosis. A decline in live-births together with a rise in termination after HIV diagnosis was a consistent finding across age and ethnic groups. However, black African women had the smallest reduction in live-births, despite the greatest increase in termination, because the pregnancy rate increased after HIV diagnosis in this group.

CONCLUSIONS

Diagnosis of HIV infection in women has a substantial impact in reducing live-birth rates. These findings have important implications for expanding HIV testing in women. They highlight the need for better understanding of reproductive decision-making in the context of HIV infection and better contraceptive support for HIV-infected women and their partners.