Consideration of Postpartum Management in HIV-positive Haitian Women: an Analysis of CD4 Decline, Mortality, and Follow-up After Delivery

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2012 Jul 31

PMID 22842846

Citations 9

Authors

Alexandra Coria

Francine Noel

Jerry Bonhomme

Vanessa Rouzier

Christian Perodin

Adias Marcelin

Zhongze Li

Tor D Tosteson

Marie-Marcelle Deschamps

Peter F Wright

Jean W Pape

Affiliations

Soon will be listed here.

Abstract

Background: A previous study at the GHESKIO HIV clinic confirmed that highly active antiretroviral therapy (HAART) prophylaxis reduced mother-to-child transmission (MTCT) and infant mortality in Haiti. This analysis looks at maternal outcomes in this cohort after delivery.

Methods: Records of 508 HIV-positive Haitian women who delivered between 1999 and 2005 were analyzed. We examined mortality, loss to follow-up, time to death or HAART initiation, and time of decline of CD4 count to 350 cells/μL.

Results: One hundred seventy women reached a CD4 ≤200 or developed clinical AIDS and were started on long-term HAART. The median CD4 count at HAART initiation was 178 (interquartile range, 106-227). CD4 decline was stratified by CD4 at delivery to project the mean months to a CD4 of 350. With an initial CD4 of 350-499 cells/μL, it was 19 months (95% confidence interval: 14 to 28) while with a CD4 >500 cells/μL, it was 71 months (95% confidence interval: 59 to 88). At study close, 257 women remained in follow-up, with loss to follow-up 3 times less in those on HAART (3.2/100 person-years) than those not on HAART (9.8/100 person-years).

Conclusions: The threshold for starting treatment was often missed in HIV-infected women after delivery. Success of follow-up of women after delivery was favorably influenced by being on HAART. Women with high (>500) initial CD4 counts had a protracted time (5-7 years) before they reach a threshold CD4 count, in contrast to those with CD4 <500 cells/μL. Strategies for postpartum treatment of women should be informed by the speed with which they are likely to progress.

Citing Articles

Maternal health outcomes among HIV-infected breastfeeding women with high CD4 counts: results of a treatment strategy trial.

Hoffman R, Angelidou K, Brummel S, Saidi F, Violari A, Dula D HIV Clin Trials. 2019; 19(6):209-224.

PMID: 30890061 PMC: 6428202. DOI: 10.1080/15284336.2018.1537327.

Treating loss-to-follow-up as a missing data problem: a case study using a longitudinal cohort of HIV-infected patients in Haiti.

Jannat-Khah D, Unterbrink M, McNairy M, Pierre S, Fitzgerald D, Pape J BMC Public Health. 2018; 18(1):1269.

PMID: 30453995 PMC: 6245624. DOI: 10.1186/s12889-018-6115-0.

Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B.

Dionne-Odom J, Massaro C, Jogerst K, Li Z, Deschamps M, Destine C AIDS Res Treat. 2016; 2016:6284290.

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Bailey H, Malyuta R, Semenenko I, Townsend C, Cortina-Borja M, Thorne C Reprod Health. 2016; 13:27.

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Maternal Highly Active Antiretroviral Therapy and Child HIV-Free Survival in Malawi, 2004-2009.

Schwartz S, Kumwenda N, Kumwenda J, Chen S, Mofenson L, Taylor A Matern Child Health J. 2015; 20(3):542-9.

PMID: 26525557 PMC: 4754130. DOI: 10.1007/s10995-015-1852-5.

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