BACKGROUND: Information is lacking on outcomes in HIV-infected Brazilian women with CD4(+) T-cell counts >200 cells/mm(3) who initiate HAART for the prevention of mother-to-child transmission, and discontinue after delivery. METHODS: Clinical event rates after postpartum HAART discontinuation were calculated for all WHO stage 2-3 events, as well as for HIV progression warranting HAART re-initiation, defined by a WHO stage 4 event and/or CD4(+) T-cell decrease to ≤200 cells/mm(3). Predictors of the WHO stage 2-3 events and HIV progression outcomes were evaluated with Cox's proportional hazards models. RESULTS: A total of 120 women were followed for a mean of 1.5 years after delivery. Overall, 26 women had 30 events as follows: 20 developed WHO stage 2-3 events, yielding an incidence rate of 13/100 person-years (PY; 95% CI 8-20); 10 developed HIV progression requiring HAART re-initiation (incidence ratio 6/100 PY, 95% CI 3-11). Among progressors, a single woman developed a WHO stage 4 clinical event and the remainder had CD4(+) T-cell decreases. Women who had baseline CD4(+) T-cell counts between 200-500 cells/mm(3) had a hazard ratio for WHO stage 2-3 events of 2.5 compared to women with baseline ≥500 cells/mm(3) (95% CI 1.0-6.3; P=0.05). The only significant predictor of HIV progression was baseline CD4(+) T-cell count (hazard ratio 0.99, 95% CI 0.98-0.99; P=0.02). CONCLUSIONS: In this observational study, a baseline CD4(+) T-cell count <500 cells/mm(3) was associated with an increased risk of postpartum WHO stage 2-3 clinical events and HIV disease progression. Randomized studies are needed to further evaluate the effect of postpartum treatment discontinuation on maternal health.
BACKGROUND: Information is lacking on outcomes in HIV-infected Brazilian women with CD4(+) T-cell counts >200 cells/mm(3) who initiate HAART for the prevention of mother-to-child transmission, and discontinue after delivery. METHODS: Clinical event rates after postpartum HAART discontinuation were calculated for all WHO stage 2-3 events, as well as for HIV progression warranting HAART re-initiation, defined by a WHO stage 4 event and/or CD4(+) T-cell decrease to ≤200 cells/mm(3). Predictors of the WHO stage 2-3 events and HIV progression outcomes were evaluated with Cox's proportional hazards models. RESULTS: A total of 120 women were followed for a mean of 1.5 years after delivery. Overall, 26 women had 30 events as follows: 20 developed WHO stage 2-3 events, yielding an incidence rate of 13/100 person-years (PY; 95% CI 8-20); 10 developed HIV progression requiring HAART re-initiation (incidence ratio 6/100 PY, 95% CI 3-11). Among progressors, a single woman developed a WHO stage 4 clinical event and the remainder had CD4(+) T-cell decreases. Women who had baseline CD4(+) T-cell counts between 200-500 cells/mm(3) had a hazard ratio for WHO stage 2-3 events of 2.5 compared to women with baseline ≥500 cells/mm(3) (95% CI 1.0-6.3; P=0.05). The only significant predictor of HIV progression was baseline CD4(+) T-cell count (hazard ratio 0.99, 95% CI 0.98-0.99; P=0.02). CONCLUSIONS: In this observational study, a baseline CD4(+) T-cell count <500 cells/mm(3) was associated with an increased risk of postpartum WHO stage 2-3 clinical events and HIV disease progression. Randomized studies are needed to further evaluate the effect of postpartum treatment discontinuation on maternal health.
Authors: D N Burns; P Nourjah; D J Wright; H Minkoff; S Landesman; A Rubinstein; J J Goedert; R P Nugent Journal: J Reprod Immunol Date: 1999-03 Impact factor: 4.054
Authors: Vlada V Melekhin; Bryan E Shepherd; Cathy A Jenkins; Samuel E Stinnette; Peter F Rebeiro; Sally S Bebawy; Daniel A Rasbach; Todd Hulgan; Timothy R Sterling Journal: AIDS Patient Care STDS Date: 2010-05 Impact factor: 5.078
Authors: Y Cao; P Krogstad; B T Korber; R A Koup; M Muldoon; C Macken; J L Song; Z Jin; J Q Zhao; S Clapp; I S Chen; D D Ho; A J Ammann Journal: Nat Med Date: 1997-05 Impact factor: 53.440
Authors: Y Mikyas; N Aziz; N Harawa; M Gorre; N Neagos; M Nogueira; D Wafer; M Dillon; P J Boyer; Y J Bryson; S Plaeger Journal: J Reprod Immunol Date: 1997-06 Impact factor: 4.054
Authors: D N Burns; S Landesman; H Minkoff; D J Wright; D Waters; R M Mitchell; A Rubinstein; A Willoughby; J J Goedert Journal: Am J Obstet Gynecol Date: 1998-02 Impact factor: 8.661
Authors: A J Melvin; S K Burchett; D H Watts; J Hitti; J P Hughes; C L McLellan; P D King; E J Johnson; B L Williams; L M Frenkel; R W Coombs Journal: J Acquir Immune Defic Syndr Hum Retrovirol Date: 1997-03-01
Authors: Risa M Hoffman; Konstantia Nadia Angelidou; Sean S Brummel; Friday Saidi; Avy Violari; Dingase Dula; Vidya Mave; Lee Fairlie; Gerhard Theron; Moreen Kamateeka; Tsungai Chipato; Benjamin H Chi; Lynda Stranix-Chibanda; Teacler Nematadzira; Dhayendre Moodley; Debika Bhattacharya; Amita Gupta; Anne Coletti; James A McIntyre; Karin L Klingman; Nahida Chakhtoura; David E Shapiro; Mary Glenn Fowler; Judith S Currier Journal: HIV Clin Trials Date: 2018-12
Authors: Maria F M Barral; Gisele R de Oliveira; Rubens C Lobato; Raul A Mendoza-Sassi; Ana M B Martínez; Carla V Gonçalves Journal: Rev Inst Med Trop Sao Paulo Date: 2014 Mar-Apr Impact factor: 1.846