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Background: HIV infection is linked to decreased fertility and fertility desires in sub-Saharan Africa due to biological and social factors. We investigate the relationship between HIV infection and fertility or fertility desires in the context of universal access to antiretroviral therapy introduced in 2004 in Rwanda. Methods: We used data from 3532 and 4527 women aged 20-49 from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHS), respectively. The RDHSs included blood-tests for HIV, as well as detailed interviews about fertility, demographic and behavioral outcomes. In both years, multiple logistic regression was used to assess the association between HIV and fertility outcomes within three age categories (20-29, 30-39 and 40-49 years), controlling for confounders and compensating for the complex survey design. Results: In 2010, we did not find a difference in the odds of pregnancy in the last 5 years between HIV-seropositive and HIV-seronegative women after controlling for potential biological and social confounders. Controlling for the same confounders, we found that HIV-seropositive women under age 40 were less likely to desire more children compared to HIV-seronegative women (20-29 years adjusted odds ratio (AOR) = 0.31, 95% CI: 0.17, 0.58; 30-39 years AOR = 0.24, 95% CI: 0.14, 0.43), but no difference was found among women aged 40 or older. No associations between HIV and fertility or fertility desire were found in 2005. Conclusions: These findings suggest no difference in births or current pregnancy among HIV-seropositive and HIV-seronegative women. That in 2010 HIV-seropositive women in their earlier childbearing years desired fewer children than HIV-seronegative women could suggest more women with HIV survived; and stigma, fear of transmitting HIV, or realism about living with HIV and prematurely dying from HIV may affect their desire to have children. These findings emphasize the importance of delivering appropriate information about pregnancy and childbearing to HIV-infected women, enabling women living with HIV to make informed decisions about their reproductive life. [ABSTRACT FROM AUTHOR]

Background CD4 cell count reference values have not yet been established in Rwanda. Objectives Describe the evolution of CD4+ subsets in HIV-exposed-uninfected children from birth to 7 months. Methods Pregnant HIV-infected women received information on PMTCT and AMATA study. Those giving informed consent were enrolled from 28 weeks of pregnancy and were given HAART systematically. The child's HIV status was assessed by DNA polymerase chain reaction. Infants aged 15 days to 7 months came for regular visits at day 1, 15, 45, month 3 and 7. Within 72 hours after birth and at every visit, peripheral blood was collected for CD4+ cell counts and PCR. CD4+ T-lymphocytes subsets expressed in absolute numbers and percentages were recorded. Results 521 infants were studied prospectively at four health centers in Rwanda. By day 1, the median CD4+ percentage is 54% (5th to 95th percentile, 37% to 67%) and the average absolute number of CD4+ cells is 1712 [164-5736]. Forty (7.7%) noninfected newborns have CD4+ cell count less than 1000. By day 15, the median CD4+ percentage is 50% (5th to 95th percentile, 31% to 62%) and the average absolute number of CD4+ cells is 2430 [407-7065]. By day 45, the median CD4+ percentage is 41% (5th to 95th percentile, 24% to 56%) and the average absolute number of CD4+ cells is 2151 [862-5776]. By 3 months, the median CD4+ percentage is 37% (5th to 95th percentile, 25% to 49%) and the average absolute number of CD4+ cells is 2071 [326-8202]. By 7 months, the median CD4+ percentage was 38% (5th to 95th percentile, 22% to 52%) and the average absolute number of CD4+ cells is 2241 [614-6236]. Conclusions Normal lymphocyte subset values among Rwandan children do not differ from those in other populations. CD4 counts are very variable for the same child. [ABSTRACT FROM AUTHOR]