HIV-positive women who want to become pregnant should be informed that pregnancy is safer during the early clinical stages of the virus, when CD4+ T cell counts are higher, according to a study published recently in Tropical Medicine & International Health, Uganda's Monitor reports.

Lieve Van der Paal of Uganda's Medical Research Council and colleagues from the Uganda Virus Research Institute examined the medical records of 139 HIV-positive women of reproductive age residing in southwestern Uganda who were in a clinical group established in 1990. The researchers examined the effect of pregnancy on HIV progression and survival among HIV-positive women before the introduction of antiretroviral drugs.

The study found that women who became pregnant had higher CD4 counts when they enrolled in the study and that they had a slower decline of CD4 cells than those who did not become pregnant. The study also found that CD4 counts declined faster after pregnancy. The researchers concluded that the "initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy." The researchers suggested that women taking antiretrovirals who have low CD4 counts wait until their CD4 counts have increased before becoming pregnant.

According to the study, HIV-positive women who want to become pregnant should be warned about the potential negative effect a pregnancy could have on their immune system's ability to fight HIV and should be offered contraception. Pregnant women living with HIV who are eligible for antiretroviral therapy "should be offered such treatment as a priority group since they are at high risk for fast progression" of HIV and because the antiretrovirals will help prevent mother-to-child HIV transmission, the study said. The study also found that since the introduction of a program aimed at preventing mother-to-child transmission, less than 5% of HIV-positive mothers in southwest Uganda do not breast-feed (Kirunda, Monitor, 9/17).

An abstract of the study is available online.

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