ArticleAIDS (London, England)2013
HIV-infected women on antiretroviral treatment have increased mortality during pregnant and postpartum periods.
Article in AIDS (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Epidemiologic and clinical characteristics ofFrontiers in cellular and infection microbiology · 2026Article
- Article
- Changes in Immune Activation During Pregnancy and the Postpartum Period in Treated HIV Infection.Open forum infectious diseases · 2021Article
- Transportation cost as a barrier to contraceptive use among women initiating treatment for HIV in Tanzania.AIDS care · 2021Article
- HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda.AIDS care · 2018Article
- "I beg you…breastfeed the baby, things changed": infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission.BMC public health · 2018Article
- Contraceptive use following unintended pregnancy among Ugandan women living with HIV.PloS one · 2018Article
- Greater involvement of HIV-infected peer-mothers in provision of reproductive health services as "family planning champions" increases referrals and uptake of family planning among HIV-infected mothers.BMC health services research · 2017Article
- High Proportion of Deaths Attributable to HIV Among Postpartum Women in Botswana Despite Widespread Uptake of Antiretroviral Therapy.AIDS patient care and STDs · 2017Article
- Implementing a Global Health Qualitative Research Study: Experiences of a Project Coordinator in Uganda.The East African health research journal · 2017Article
- Contraceptive use among HIV-infected women and men receiving antiretroviral therapy in Lusaka, Zambia: a cross-sectional survey.BMC public health · 2016Article
- Estimation of mortality among HIV-infected people on antiretroviral treatment in East Africa: a sampling based approach in an observational, multisite, cohort study.The lancet. HIV · 2015Observational
- A Systematic Review of Interventions to Reduce Maternal Mortality among HIV-Infected Pregnant and Postpartum Women.International journal of MCH and AIDS · 2015Review
- Eliminating preventable HIV-related maternal mortality in sub-Saharan Africa: what do we need to know?Journal of acquired immune deficiency syndromes (1999) · 2014Review
- Incidence of pregnancy after antiretroviral therapy initiation and associated factors in 8 West African countries.Journal of acquired immune deficiency syndromes (1999) · 2014Article
- Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet (London, England) · 2014Article
- Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in Uganda.AIDS research and treatment · 2014Article
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Authors and funding
11 authors.
Funding
Abstract
objectiveTo assess the impact of pregnancy on mortality among HIV-infected Ugandan women initiating ART.
designProspective cohort study.
methodsHIV-infected women initiating ART in the Uganda AIDS Rural Treatment Outcomes study were assessed quarterly for self-reported pregnancy. The association between pregnancy and postpartum ('pregnancy-related') follow-up periods and mortality was assessed with Cox proportional hazards models adjusted for age, CD4 cell count, plasma HIV-1 RNA levels, and ART duration.
resultsThree hundred and fifty-four women with median age 33 years (IQR: 27-37) and CD4 142 cells/μl (IQR: 82-213) were followed for a median of 4.0 years (IQR: 2.5-4.8) after ART initiation, with 3 and 7% loss-to-follow-up at years 1 and 5. One hundred and nine women experienced pregnancy. Five deaths occurred during pregnancy-related follow-up and 16 during nonpregnancy-related follow-up, for crude mortality rates during the first year after ART initiation of 12.57/100 PYs and 3.53/100 PYs (rate ratio 3.56, 95% CI: 0.97-11.07). In adjusted models, the impact of pregnancy-related follow-up on mortality was highest at ART initiation (aHR: 21.48, 95% CI: 3.73-123.51), decreasing to 13.44 (95% CI 3.28-55.11) after 4 months, 8.28 (95% CI 2.38-28.88) after 8 months, 5.18 (95% CI: 1.36-19.71) after 1 year, and 1.25 (95% CI: 0.10-15.58) after 2 years on ART. Four of five maternal deaths occurred postpartum.
conclusionPregnancy and the postpartum period were associated with increased mortality in HIV-infected women initiating ART, particularly during early ART. Contraception proximate to ART initiation, earlier ART initiation, and careful monitoring during the postpartum period may reduce maternal mortality in this setting.
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