Pregnancy rates rise in women after beginning ART

The chance of becoming pregnant not only increased over four years of antiretroviral treatment, but was almost 80% higher for HIV-infected women who began antiretroviral therapy than for HIV-infected women not on treatment enrolled in the Mother-to-Child Transmission Plus (MTCT Plus)-Initiative in seven sub-Saharan countries, report Landon Myer and colleagues in a study published in the February online edition of PLoS Medicine.

The authors note their findings suggest an association between increased pregnancy rates and starting antiretroviral therapy. Thirty percent of all women on ART during this time became pregnant. While the authors acknowledge the uncertainty of the reasons for this link, it nonetheless highlights the (neglected) need for pregnancy planning and management as a key component of HIV treatment and care they stress.

The increasing roll-out of antiretroviral therapy in resource-poor settings, notably in sub-Saharan Africa, has resulted in improved health, fertility and life expectancy. This has important implications for HIV-infected women of reproductive age and their partners for pregnancy and childbearing as well as the health and wellbeing of women and their children. Yet, the authors note, there is little information on the effects of antiretroviral treatment on pregnancy rates.

The Mother-to-Child Transmission Plus (MTCT-Plus) Initiative is an HIV care and treatment programme for women, children and families and includes 11 programmes in seven countries.

The authors analysed the data of 4,531 women enrolled at the 11 sites from February 2003 to January 2007 to compare pregnancy rates amongst those on ART and those not on ART during this time period. A total of 589 pregnancies were seen among all women, of which 244 occurred among those not on ART compared to 345 pregnancies among those on ART, or 30% of those on treatment.

They note that the rate of new pregnancies among women on ART (9.0/100 person-years) was considerably higher than those not on ART (6.5/100 person-years) (adjusted hazard ration, 1.74; 95% CI: 1.19-2.54).

Other factors the authors highlight that were independently associated with increased risk for pregnancy include younger age, lower educational status, being married or living with someone, having a male partner enrolled in the programme, not using a non-barrier contraception such as injectable hormones and higher CD cell counts.

The association between the lack of use of non-barrier contraceptives and pregnancy highlights, according to the authors, the limited effectiveness of condoms used alone as a contraceptive, and they stress the importance of dual method use.

The authors note that while not clearly understood, the rates of pregnancy do increase significantly following antiretroviral treatment and conclude “Although the precise reasons for this increase require additional research, HIV care and treatment programmes have an important opportunity to address women’s fertility intentions and to shape their services to address the needs of the women and their families over time.”