More positively, in more recent calendar years the incidence of abortion after HIV diagnosis was lower and comparable to that reported for Italian women in general. This finding has several implications. First, it suggests that the impact of HIV infection on the desire to have children and the decision to terminate pregnancy may have changed over time in HIV-positive women. Indeed, the awareness of HIV infection had a significant

effect only in the 1980s, when women who knew that they were HIV-infected had a 2.5-fold higher risk of abortion compared with those who were unaware of their serostatus. During the 1990s, the incidences of abortion before and after HIV diagnosis were comparable. However, the incidence GSI-IX in vivo in HIV-infected Apoptosis inhibitor women (either before or after diagnosis) was almost twofold that reported for the Italian HIV-negative population [17], suggesting that, regardless of awareness of infection, women

with HIV infection at that time had to be considered a particularly vulnerable group. Hence, our results confirm those of previously published reports indicating that contraception in HIV-infected women is generally suboptimal [18-21]. Many factors may account for unprotected sexual practices among HIV-positive women, including difficulties in negotiating condom use, in particular when they have an

HIV-positive partner [20]. Beliefs regarding lower levels of infectivity under antiretroviral therapy are also associated with less condom use. Studies have reported higher levels of unprotected sex among women after antiretroviral treatment initiation, which did not vary with the therapeutic response [21]. More recently, awareness of HIV infection was again found not to be related to the risk of abortion, and the lower incidence of abortion observed among HIV-positive women aware of their status may partially reflect temporal trends in the epidemiology of HIV acquisition, with the progressive substitution of IDU with women who acquired infection through sexual transmission [1, 13-16]. This change in epidemiology in recent years may also Liothyronine Sodium explain the lack of an association between mode of HIV transmission and abortion documented when we studied only PYFU after HIV diagnosis. The decrease in the abortion rate in the later HAART era has already been described elsewhere [4], and mainly reflects the better life expectancy of HIV-infected women provided by efficient antiretroviral drugs and the wide availability of MTCT protocols, which has increased positive attitudes towards motherhood. Furthermore, the current use of antiretroviral therapy was protective against abortion, after adjusting for other factors.