HIV-infected women on antiretroviral treatment have increased mortality during pregnant and postpartum periods

Lynn T. Matthews, Angela Kaida, Steven Kanters, Helen Byakwagamd, A. Rain Mocello, Conrad Muzoora, Annet Kembabazi, Jessica E. Haberer, Jeffrey N. Martin, David R. Bangsberg, Peter W. Hunt

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


OBJECTIVE:: To assess the impact of pregnancy on mortality among HIV-infected Ugandan women initiating ART. DESIGN:: Prospective cohort study. METHODS:: HIV-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. RESULTS:: Three 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. CONCLUSION:: Pregnancy 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.

Original languageEnglish (US)
Pages (from-to)S105-S112
Issue numberSUIPPL.1
StatePublished - Oct 2013
Externally publishedYes


  • Africa
  • HIV
  • antiretroviral therapy
  • immune reconstitution
  • maternal health
  • maternal mortality
  • mortality
  • postpartum
  • pregnancy
  • women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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