The contribution of hiv to pregnancy-related mortality: a systematic review and meta-analysis.


Calvert, C; Ronsmans, C; (2013) The contribution of hiv to pregnancy-related mortality: a systematic review and meta-analysis. AIDS (London, England), 27 (10). pp. 1631-9. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0b013e32835fd940

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Abstract

OBJECTIVES: Although much is known about the contribution of HIV to adult mortality, remarkably little is known about the mortality attributable to HIV during pregnancy. In this article we estimate the proportion of pregnancy-related deaths attributable to HIV based on empirical data from a systematic review of the strength of association between HIV and pregnancy-related mortality.<br/> METHODS: Studies comparing mortality during pregnancy and the postpartum in HIV-infected and HIV-uninfected women were included. Summary estimates of the relative and attributable risks for the association between HIV and pregnancy-related mortality were calculated through meta-analyses. Varying estimates of HIV prevalence were used to predict the impact of the HIV epidemic on pregnancy-related mortality at the population level.<br/> RESULTS: Twenty-three studies were included (17 from sub-Saharan Africa). Meta-analysis of the risk ratios indicated that HIV-infected women had eight times the risk of a pregnancy-related death compared with HIV-uninfected women [pooled risk ratio 7.74, 95% confidence interval (95% CI) 5.37-11.16]. The excess mortality attributable to HIV among HIV-infected pregnant and postpartum women was 994 per 100,000 pregnant women. We predict that 12% of all deaths during pregnancy and up to 1-year postpartum are attributable to HIV/AIDS in regions with a prevalence of HIV among pregnant women of 2%. This figure rises to 50% in regions with a prevalence of 15%.<br/> CONCLUSION: The substantial excess of pregnancy-related mortality associated with HIV highlights the importance of integrating HIV and reproductive health services in areas of high HIV prevalence and pregnancy-related mortality.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Maternal Health Group
ALPHA Network
Centre for Maternal, Reproductive and Child Health (MARCH)
Population Studies Group
PubMed ID: 23435296
Web of Science ID: 326840700012
URI: http://researchonline.lshtm.ac.uk/id/eprint/617521

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