Compared with the live birth rate in HIV-infected women before the advent of highly active antiretroviral therapy (HAART), the rate in the HAART era has increased 150%, investigators with the Women's Interagency HIV Study report in the June issue of the American Journal of Obstetrics and Gynecology.
The initial study enrollment occurred in 1994-1995, during the pre-HAART era. A second enrollment occurred between 2001 and 2002, during the HAART era.
There were 569 HIV-negative women and 2,012 HIV-positive women enrolled in the first phase of the study, and 405 HIV-negative women and 476 HIV-positive women enrolled during the HAART era. Mean age of the first group was 29 years and mean age of the second group was 33 years.
The live birth rate in the pre-HAART era ranged from 42.4 per 1,000 person-years for women with CD4 cell counts at enrollment below 200, to 70.2 per 1,000 person-years for women with CD4 cell counts above 350.
The live birth rate in the HAART era was 198.5 per 1000 person-years for women with CD4 cell counts below 200, and 142.6 per 1,000 person-years for women with CD4 cell counts above 350.
"We found that live birth rates for women not infected with HIV have remained relatively constant," at 101.6 to 106.7 live births per 1,000 person-years, lead investigator Dr. Anjali Sharma of the State University of New York Downstate Medical Center in Brooklyn commented in an interview with Reuters Health.
"It is difficult to definitively determine the reasons for this increase in live birth rate seen" in the post-HAART era, Dr. Sharma continued. "It may be due to better health of the mother, which leads to improved fertility."
"Or perhaps women's knowledge of available treatments to prevent HIV infection of the fetus makes carrying a pregnancy to term an option chosen more often, as those women receiving successful HAART regimen are unlikely to transmit HIV to the fetus," the investigator surmised, noting that a vertical HIV transmission rate as low as 1%-2% is now achievable.
"Additionally, better overall life expectancy for the mother may be a key factor," Dr. Sharma added, "as women with HIV can expect to live to care for their children in the HAART era."
Am J Obstet Gynecol 2007;196:541.e1-541.e6.
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