In PLoS Medicine this week a study conducted in a
multi-country HIV treatment program in sub-Saharan Africa has found
that pregnancy rates increase in HIV-infected women after they
start antiretroviral therapy (ART).
In sub-Saharan Africa childbirth plays an important role in
spreading HIV from mother to child. By the end of 2007 there were
almost 3 million HIV-infected people receiving antiretroviral care
in poor countries. ART reduces, but does not remove, the chances of
a mother passing HIV to her child during birth. In this study
Landon Myer of the University of Cape Town, South Africa, and
colleagues analyzed data from the Mother-to-Child Transmission-Plus
initiative (MTCT-Plus) to see how ART impacted on pregnancy rates
amongst HIV-infected woman.
In seven African countries the MTCT-Plus initiative offers
family-centred treatment, including check-ups, blood tests,
counselling and ART when appropriate. Over a four year period, the
researchers found that nearly a third of the women starting
antiretroviral therapy experienced a pregnancy. The researchers
found that the chance of pregnancy increased over time in women who
had started to receive ART, whilst pregnancy rates remained low and
constant in women who were not yet receiving ART. As expected,
other factors, such as age, lower educational status, and less
reliable forms of contraception also affected pregnancy rates.
The study cannot explain why women receiving ART are more likely
to become pregnant – the authors offer behavioural
explanations, such as the fact that women receiving ART are more
likely to feel motivated to have children as their health improves.
The authors acknowledge limitations of their study, including the
fact that they were relying on women self-reporting pregnancy which
may mean that some pregnancies were not detected. The results of
this study indicate that HIV treatment programs have "an important
opportunity to address women's fertility intentions and to shape
their services to address the needs of women and their families
over time."
Funding: The MTCT-Plus Initiative is funded through grants from
the following philanthropic foundations: Bill & Melinda Gates
Foundation, William and Flora Hewlett Foundation, David and Lucile
Packard Foundation, Robert Wood Johnson Foundation, Henry J. Kaiser
Family Foundation, John D. and Catherine T. MacArthur Foundation,
Rockefeller Foundation, and Starr Foundation. Additional support is
provided by the United States Agency for International Development.
The funding agencies played no role in the design and conduct of
the study; the collection, management, analysis, and interpretation
of the data; and the preparation, review, or approval of the
manuscript.
Competing Interests: The authors have declared that no competing
interests exist.
Citation: Myer L, Carter RJ, Katyal M, Toro P, El-Sadr WM, et
al. (2010) Impact of Antiretroviral Therapy on Incidence of
Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort
Study. PLoS Med 7(2): e1000229.
doi:10.1371/journal.pmed.1000229
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CONTACT:
Landon Myer
University of Cape Town
School of Public Health and Family Medicine
Faculty of Health Sciences, University of Cape Town
Anzio Road, Observatory
Cape Town, Western Cape 7925
South Africa
27 21 406 6661
27 21 406 6764 (fax)
landon.myer@uct.ac.za
Developing global maps of the dominant Anopheles vectors of
human malaria
Simon Hay (University of Oxford, UK) and colleagues describe how
the Malaria Atlas Project has collated data on the occurrence of
Anopheles mosquitoes to map the geographic distributions of the
dominant mosquito vectors of human malaria.
Funding: SIH is funded by a Senior Research Fellowship from the
Wellcome Trust (#079091) which also supports PWG, APP, and WHT.
MES, CWK, PMM, CCT, and REH are funded by a Wellcome Trust project
grant (#083534) to SIH. RMO is funded by a Wellcome Trust Masters
Training Fellowship (#083124). This work forms part of the output
of the Malaria Atlas Project (MAP, http://www.map.ox.ac.uk),
principally funded by the Wellcome Trust, UK. The funders had no
role in study design, data collection and analysis, decision to
publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing
interests exist.
Citation: Hay SI, Sinka ME, Okara RM, Kabaria CW, Mbithi PM, et
al. (2010) Developing Global Maps of the Dominant Anopheles Vectors
of Human Malaria. PLoS Med 7(2): e1000209.
doi:10.1371/journal.pmed.1000209.
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FREELY AVAILABLE PAPER:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000209
PRESS-ONLY PREVIEW OF THE ARTICLE: www.plos.org/press/plme-07-02-hay.pdf
CONTACT:
Simon Hay
University of Oxford
Department of Zoology
Tinbergen Building
South Parks Road
Oxford, Oxfordshire OX1 3PS
United Kingdom
+44 1865 271243
+44 1865 271243 (fax)
simon.hay@zoo.ox.ac.uk
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