Zaba, Basia, Clara Calvert, Milly Marston, Raphael Isingo, Jessica Nakiyingi-Miiro, Tom Lutalo, Amelia Crampin, Laura Robertson, Kobus Herbst, Marie-Louise Newell, Jim Todd, Peter Byass, Ties Boerma, and Carine Ronsmans. “Effect of HIV Infection on Pregnancy-Related Mortality in Sub-Saharan Africa: Secondary Analyses of Pooled Community-Based Data from the Network for Analysing Longitudinal Population-Based HIV/AIDS Data on Africa (ALPHA).” Lancet 381, no. 9879 (2013): 1763-71. doi:10.1016/S0140-6736(13)60803-X.

URL: www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60803-X/abstract

Abstract:

Background: Model-based estimates of the global proportions of maternal deaths that are in HIV-infected women range from 7% to 21%, and the effects of HIV on the risk of maternal death is highly uncertain. We used longitudinal data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network to estimate the excess mortality associated with HIV during pregnancy and the post-partum period in sub-Saharan Africa.

Findings: 138,074 women aged 15–49 years contributed 636,213 person-years of observation. 49,568 women had 86,963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17·2% (95% CI 17·0–17·3), but 60 of 118 (50·8%) of the women of known HIV status who died during pregnancy or post-partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20·5 (18·9–22·4) in women who were not pregnant or post partum and 8·2 (5·7–11·8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51·8 (47·8–53·8) per 1000 person-years in women who were not pregnant or post partum and 11·8 (8·4–15·3) per 1000 person-years in pregnant or post-partum women.

Interpretation: HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.

The spread of HIV/AIDS has severely hindered efforts to reduce maternal mortality, particularly in sub-Saharan Africa where the prevalence of HIV remains high. In order to more accurately assess the impact of HIV/AIDS in sub-Saharan Africa, Basia Zaba et al. pool data from six large community-based studies in order to estimate the excess number of deaths during pregnancy and the post-partum period that could be attributed to HIV/AIDS. These researchers concluded that almost 25% of maternal deaths in sub-Saharan Africa were attributable to HIV/AIDS, emphasizing the need to include HIV/AIDS prevention interventions in the effort to improve maternal survival.