Impact of ART on the Fertility of HIV-Positive Women in Sub-Saharan Africa
File(s)
Author(s)
Type
Journal Article
Abstract
Objective
Understanding the fertility of HIV-positive women is critical to estimating HIV epidemic trends from surveillance data and planning resource needs and coverage of prevention-of-mother-to-child transmission services in sub-Saharan Africa. In light of the considerable scale-up in antiretroviral therapy (ART) coverage over the last decade, we conducted a systematic review of the impact of ART on the fertility outcomes of HIV-positive women.
Methods
We searched Medline, Embase, Popline, PubMed and African Index Medicus. Studies were included if they were conducted in sub-Saharan Africa and provided estimates of fertility outcomes (live births or pregnancies) among women on ART relative to a comparison group.
Results
Of 2070 unique references, 18 published papers met all eligibility criteria. Comparisons fell into four categories: fertility of HIV-positive women relative to HIV-negative women; fertility of HIV-positive women on ART compared to those not yet on ART; fertility differences by duration on ART; and temporal trends in fertility among HIV-positive women. Evidence indicates that fertility increases after approximately the first year on ART, and that while the fertility deficit of HIV-positive women is shrinking, their fertility remains below that of HIV-negative women. These findings, however, were based on limited data mostly during the period 2005-2010 when ART scaled up.
Conclusions
Existing data are insufficient to characterize how ART has affected the fertility of HIV-positive women in sub-Saharan Africa. Improving evidence about fertility among women on ART is an urgent priority for planning HIV resource needs and understanding HIV epidemic trends. Alternative data sources such as antenatal clinic data, general population cohorts and population-based surveys can be harnessed to understand the issue.
Understanding the fertility of HIV-positive women is critical to estimating HIV epidemic trends from surveillance data and planning resource needs and coverage of prevention-of-mother-to-child transmission services in sub-Saharan Africa. In light of the considerable scale-up in antiretroviral therapy (ART) coverage over the last decade, we conducted a systematic review of the impact of ART on the fertility outcomes of HIV-positive women.
Methods
We searched Medline, Embase, Popline, PubMed and African Index Medicus. Studies were included if they were conducted in sub-Saharan Africa and provided estimates of fertility outcomes (live births or pregnancies) among women on ART relative to a comparison group.
Results
Of 2070 unique references, 18 published papers met all eligibility criteria. Comparisons fell into four categories: fertility of HIV-positive women relative to HIV-negative women; fertility of HIV-positive women on ART compared to those not yet on ART; fertility differences by duration on ART; and temporal trends in fertility among HIV-positive women. Evidence indicates that fertility increases after approximately the first year on ART, and that while the fertility deficit of HIV-positive women is shrinking, their fertility remains below that of HIV-negative women. These findings, however, were based on limited data mostly during the period 2005-2010 when ART scaled up.
Conclusions
Existing data are insufficient to characterize how ART has affected the fertility of HIV-positive women in sub-Saharan Africa. Improving evidence about fertility among women on ART is an urgent priority for planning HIV resource needs and understanding HIV epidemic trends. Alternative data sources such as antenatal clinic data, general population cohorts and population-based surveys can be harnessed to understand the issue.
Date Issued
2016-07-02
Date Acceptance
2016-06-28
Citation
Tropical Medicine & International Health, 2016, 21 (9), pp.1071-1085
ISSN
1365-3156
Publisher
Wiley
Start Page
1071
End Page
1085
Journal / Book Title
Tropical Medicine & International Health
Volume
21
Issue
9
Copyright Statement
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/tmi.12747
Sponsor
UNAIDS
Grant Number
PO201153562
Subjects
Afrique subsaharienne
HIV
VIH
analyse systématique
antiretroviral therapy
births
embarazo
fertilidad
fertility
fertilité
grossesse
nacimientos
naissances
pregnancy
revisión sistemática
sub-Saharan Africa
systematic review
terapia antiretroviral
thérapie antirétrovirale
África subsahariana
Tropical Medicine
1117 Public Health And Health Services
Publication Status
Published