HIV Disease Progression in the First Year After Delivery Among African Women Followed in the HPTN 046 Clinical Trial

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2013 Jul 13

PMID 23846568

Citations 6

Authors

D Heather Watts

Elizabeth R Brown

Yvonne Maldonado

Casey Herron

Tsungai Chipato

Leanne Reddy

Dhayendre Moodley

Clemensia Nakabiito

Karim Manji

Wafaie Fawzi

Kathleen George

Paul Richardson

Sheryl Zwerski

Hoosen Coovadia

MaryGlenn Fowler

Affiliations

Soon will be listed here.

Abstract

Background: Starting lifelong antiretroviral therapy (ART) in HIV-infected pregnant women may decrease HIV progression and transmission, but adherence after delivery may be difficult, especially for asymptomatic women. We evaluated disease progression among HIV-infected women not on ART with CD4⁺ lymphocyte counts above 200 cells per microliter at delivery.

Methods: We analyzed risk of death, progression to AIDS (stage IV or CD4 < 200 cells per microliter), or to CD4⁺ count <350 1 year after delivery among postpartum women enrolled to a prevention of breastfeeding transmission trial using the Kaplan-Meier method. In the primary analysis, women were censored if ART was initiated.

Results: Among 1285 women who were not WHO stage IV or less at 6 weeks postpartum, 49 (4.3%) progressed to stage IV/CD4 <200 cells per microliter or death by 1 year. Progression to CD4 <200 cells per microliter or death occurred among 16 (4.3%) of 441 women with CD4 count of 350-549 cells per microliter and 10 (1.6%) of 713 with CD4 counts >550 cells per microliter at delivery. CD4 <350 cells per microliter by 12 months postpartum occurred among 116 (37.0%) of 350 women with CD4 count 400-549 cells per microliter and 48 (7.4%) of 713 with CD4 count >550 cells per microliter at delivery.

Conclusions: Progression to AIDS or CD4 count <350 cells per microliter is uncommon through 1 year postpartum for women with CD4 counts over 550 cells per microliter at delivery, but occurred in over one third of those with CD4 counts under 550 cells per microliter. ART should be continued after delivery or breastfeeding among women with CD4 counts <550 cells per microliter if follow-up and antiretroviral adherence can be maintained.

Citing Articles

Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice.

Duthely L, Sanchez-Covarrubias A Front Commun (Lausanne). 2021; 5.

PMID: 33644162 PMC: 7909469. DOI: 10.3389/fcomm.2020.530164.

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.

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.

The association between the ratio of monocytes: lymphocytes and risk of tuberculosis among HIV-infected postpartum women.

Naranbhai V, Moodley D, Chipato T, Stranix-Chibanda L, Nakabaiito C, Kamateeka M J Acquir Immune Defic Syndr. 2014; 67(5):573-5.

PMID: 25247435 PMC: 4229408. DOI: 10.1097/QAI.0000000000000353.

Immunologic status and virologic outcomes in repeat pregnancies to HIV-positive women not on antiretroviral therapy at conception: a case for lifelong antiretroviral therapy?.

French C, Thorne C, Tariq S, Cortina-Borja M, Tookey P AIDS. 2014; 28(9):1369-72.

PMID: 24685820 PMC: 4032213. DOI: 10.1097/QAD.0000000000000282.

References

Coria A, Noel F, Bonhomme J, Rouzier V, Perodin C, Marcelin A . Consideration of postpartum management in HIV-positive Haitian women: an analysis of CD4 decline, mortality, and follow-up after delivery. J Acquir Immune Defic Syndr. 2012; 61(5):636-43. PMC: 3767139. DOI: 10.1097/QAI.0b013e31826abdd1. View

Fawzi W, Msamanga G, Hunter D, Renjifo B, Antelman G, Bang H . Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality. AIDS. 2002; 16(14):1935-44. DOI: 10.1097/00002030-200209270-00011. View

Kuhn L, Aldrovandi G, Sinkala M, Kankasa C, Mwiya M, Thea D . Potential impact of new WHO criteria for antiretroviral treatment for prevention of mother-to- child HIV transmission. AIDS. 2010; 24(9):1374-7. PMC: 2946203. View

Brown E, Otieno P, Mbori-Ngacha D, Farquhar C, Obimbo E, Nduati R . Comparison of CD4 cell count, viral load, and other markers for the prediction of mortality among HIV-1-infected Kenyan pregnant women. J Infect Dis. 2009; 199(9):1292-300. PMC: 2758232. DOI: 10.1086/597617. View

Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E . High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Trop Med Int Health. 2005; 10(12):1242-50. DOI: 10.1111/j.1365-3156.2005.01526.x. View

Nachega J, Marconi V, van Zyl G, Gardner E, Preiser W, Hong S . HIV treatment adherence, drug resistance, virologic failure: evolving concepts. Infect Disord Drug Targets. 2011; 11(2):167-74. PMC: 5072419. DOI: 10.2174/187152611795589663. View

Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N . Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365(6):493-505. PMC: 3200068. DOI: 10.1056/NEJMoa1105243. View

Coovadia H, Brown E, Fowler M, Chipato T, Moodley D, Manji K . Efficacy and safety of an extended nevirapine regimen in infant children of breastfeeding mothers with HIV-1 infection for prevention of postnatal HIV-1 transmission (HPTN 046): a randomised, double-blind, placebo-controlled trial. Lancet. 2011; 379(9812):221-8. PMC: 3539769. DOI: 10.1016/S0140-6736(11)61653-X. View

Wang B, Losina E, Stark R, Munro A, Walensky R, Wilke M . Loss to follow-up in a community clinic in South Africa--roles of gender, pregnancy and CD4 count. S Afr Med J. 2011; 101(4):253-7. PMC: 3834586. DOI: 10.7196/samj.4078. View

10.

Richardson B, Otieno P, Mbori-Ngacha D, Overbaugh J, Farquhar C, John-Stewart G . Hormonal contraception and HIV-1 disease progression among postpartum Kenyan women. AIDS. 2007; 21(6):749-53. PMC: 3380082. DOI: 10.1097/QAD.0b013e328032790f. View

11.

Ekama S, Herbertson E, Addeh E, Gab-Okafor C, Onwujekwe D, Tayo F . Pattern and determinants of antiretroviral drug adherence among Nigerian pregnant women. J Pregnancy. 2012; 2012:851810. PMC: 3317105. DOI: 10.1155/2012/851810. View

12.

Pilotto J, Velasque L, Friedman R, Moreira R, Veloso V, Grinsztejn B . Maternal outcomes after HAART for the prevention of mother-to-child transmission in HIV-infected women in Brazil. Antivir Ther. 2011; 16(3):349-56. PMC: 3437753. DOI: 10.3851/IMP1779. View

13.

Ekouevi D, Abrams E, Schlesinger M, Myer L, Phanuphak N, Carter R . Maternal CD4+ cell count decline after interruption of antiretroviral prophylaxis for the prevention of mother-to-child transmission of HIV. PLoS One. 2012; 7(8):e43750. PMC: 3428298. DOI: 10.1371/journal.pone.0043750. View

14.

Ahoua L, Ayikoru H, Gnauck K, Odaru G, Odar E, Ondoa-Onama C . Evaluation of a 5-year programme to prevent mother-to-child transmission of HIV infection in Northern Uganda. J Trop Pediatr. 2009; 56(1):43-52. DOI: 10.1093/tropej/fmp054. View

15.

Chilongozi D, Wang L, Brown L, Taha T, Valentine M, Emel L . Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania. Pediatr Infect Dis J. 2008; 27(9):808-14. PMC: 2739309. DOI: 10.1097/INF.0b013e31817109a4. View

16.

Nachega J, Uthman O, Anderson J, Peltzer K, Wampold S, Cotton M . Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012; 26(16):2039-52. PMC: 5061936. DOI: 10.1097/QAD.0b013e328359590f. View

17.

Landes M, van Lettow M, Bedell R, Mayuni I, Chan A, Tenthani L . Mortality and health outcomes in HIV-infected and HIV-uninfected mothers at 18-20 months postpartum in Zomba District, Malawi. PLoS One. 2012; 7(9):e44396. PMC: 3433431. DOI: 10.1371/journal.pone.0044396. View