Reduced fertility in women with HIV infection; a population-based study in Uganda.

Pregnancy was investigated among 4813 sexually active women aged 15-49 in rural Rakai District of southwestern Uganda who reported at least one sex partner during the previous year and provided a blood sample for HIV serology. 19.3% were pregnant with 83.7% of those pregnancies reported by the woman and 16.3% detected by urinary hCG. 953 (19.8%) women were infected with HIV-1. The prevalence of HIV infection varied by age from 7.3% among women aged 15-19 26.5% in the 20-29 age group 21.7% in women aged 30-39 and 9.7% in women aged 40-49. The prevalence of active syphilis was 9.3%. 21.4% of women infected with neither HIV nor syphilis were pregnant compared to 14.2% of HIV-negative women with active syphilis 8.5% of HIV-positive women with syphilis and 13.4% of HIV-positive women without syphilis. The age-specific pregnancy rates were lower in the HIV-infected than in the control women in all age groups. However among the HIV-negative women with active syphilis the reduction in pregnancy rates was mainly observed in the youngest age group 15-19. These younger women are likely to have relatively recent infections; early syphilis has a severe impact upon pregnancy loss. Among the 953 HIV-infected women 87.4% had no symptoms or signs suggestive of clinical HIV disease; 14.3% of these asymptomatic subjects were pregnant. Only 7.5% of 120 symptomatic HIV-infected women were pregnant. Pregnancy rates in the symptomatic HIV-positive women were 0% in 5 women with herpes zoster 5.9% in 34 women with chronic cough 6.5% in 31 women with oral candidiasis and 8.8% in 80 women who reported weight loss.