Impaired fertility associated with HIV-1 - Implications for antenatal clinic-based HIV sentinel surveillance

Background: Given the relationship between HIV infection and fertility, ant enatal clinic-based HIV prevalence may not provide a goon estimate of the c ommunity HIV prevalence. The objective of this work was to evaluate the imp act of HIV infection on fertility among women attending antenatal clinics i n Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HI V sentinel surveillance. Methods: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME-ANRS 049 trial) we consecutively pr oposed voluntary counselling and HIV testing (VCT) to 1349 women aged at le ast 18 years, carrying a pregnancy of 7 months or less and living in Bobo-D ioulasso. During pre-rest counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demograph ic characteristics and obstetrical history. Blood samples were then taken a nd tested for HIV after written informed consent. Results: Mean age (+/- standard deviation) at first sexual intercourse was similar among HN-infected (HIV+) (16.7 +/-2; n =83) and HIV-negative (HIV-) women (16.9 +/-2; n=1336). However, HIV+ women aged 25 years and above had , on the average fewer pregnancies (3.8 +/-1.5; n=37) than HIV- women (5.0 +/-2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less l ive births (2.8<plus/minus>1.3; n=35) than HIV- ones (3.7 +/-2.1; n=555), p =0.02. Other sexual and obstetrical characteristics such as maternal age, p roportion of primigravidae, stillbirths or spontaneous abortions were compa rable between HIV+ and HIV- women. Conclusions: Our data suggest that the level of fertility of HIV+ women age d 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among ante natal clinic attendees. These findings suggest adjusting antenatal clinic-b ased HIV sentinel surveillance data for age and fertility in order to deriv e a good estimate of the community HIV prevalence.