HIV-1 infection and reproductive history: a retrospective study among pregnant women, Abidjan, Côte d'Ivoire, 1995-1996. Ditrame Project.

The aim of this paper is to determine the differences of fertility between HIV-1 infected and uninfected women in Abidjan, Côte d'Ivoire, using data available in an observational study conducted in 1995 and 1996 in 2 antenatal care centres in the district of Yopougon, Abidjan, within an intervention programme to reduce mother-to-child HIV-1 transmission (DITRAME project, ANRS 049). Fertility indicators have been constructed from retrospective data on pregnancies and births, and univariate and multivariate analyses have been performed on these indicators and stratified by age groups to compare HIV-1 positive and HIV-negative populations. The main outcome measures were the number of pregnancies, the number of miscarriages, the risk of miscarriage and the proportion of primigravida. Four thousand, three hundred and ninety-six women agreed to HIV testing: 12.1% were found to be HIV-1 infected. HIV-1 positive women had significantly fewer pregnancies than HIV-negatives in age-groups 25-29 (P = 0.05) and 30-34 (P = 0.008). The risk of having had at least one abortion or stillbirth was significantly higher for HIV-1 infected women than for HIV-negatives (OR = 1.28, 95% CI: 1.02-1.60), when controlling for social and demographic factors. This study suggests that HIV-1 infection has deleterious consequences on female fertility, with lower fertility rates and more frequent adverse pregnancy outcomes. Family planning and antenatal care services should consider antenatal HIV counselling and testing in women in areas of high HIV prevalence.