The effects of HIV on fertility by infection duration: evidence from African population cohorts before ART availability: Fertility by duration of HIV infection
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
OBJECTIVES: To estimate the relationship between HIV natural history and fertility by duration of infection in East and Southern Africa before the availability of antiretroviral therapy, and assess potential biases in estimates of age-specific sub-fertility when using retrospective birth histories in cross-sectional studies. DESIGN: Pooled analysis of prospective population-based HIV cohort studies in Masaka (Uganda) Kisesa (Tanzania), and Manicaland (Zimbabwe). METHODS: Women aged 15-49 who had ever tested for HIV were included. Analyses were censored at antiretroviral treatment roll out. Fertility rate ratios were calculated to see the relationship of duration of HIV infection on fertility, adjusting for background characteristics. Survivorship and misclassification biases on age-specific subfertility estimates from cross-sectional surveys were estimated by reclassifying person time from the cohort data to simulate cross-sectional surveys and comparing fertility rate ratios to true cohort results. RESULTS: HIV negative and positive women contributed 15,440 births and 86320 person years; and 1,236 births and 11240 thousand person years respectively to the final dataset. Adjusting for age, study site and calendar year, each additional year since HIV sero conversion was associated with a 0.02 (95%CI 0.01-0.03) relative decrease infertility for HIV-positive women. Survivorship and misclassification biases in simulated retrospective birth histories resulted in modest underestimates of sub-fertility by 2-5% for age groups 20-39y. CONCLUSION: Longer duration of infection is associated with greater relative fertility reduction for HIV-positive women. This should be considered when creating estimates for HIV prevalence among pregnant women and PMTCT need over the course of the HIV epidemic and ART scale-up.
Date Issued
2016-10-20
Date Acceptance
2016-10-10
Citation
AIDS, 2016, 31, pp.S69-S76
ISSN
1473-5571
Publisher
Wolters Kluwer Health
Start Page
S69
End Page
S76
Journal / Book Title
AIDS
Volume
31
Copyright Statement
© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the
Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Sponsor
Wellcome Trust
UNAIDS
Identifier
http://www.ncbi.nlm.nih.gov/pubmed/27776040
Grant Number
084401/Z/07/Z
PO201153562
Subjects
Virology
06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status
Published
Coverage Spatial
England