Alfred A Kamuyango1, Lisa R Hirschhorn2, Wenjia Wang3, Perry Jansen4, Risa M Hoffman5. 1. Department of Pathology, College of Medicine, Blantyre, Malawi Mahatma Gandhi Road Blantyre, Malawi. 2. Department of Global Health and Social Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA. 3. Department of Statistics, University of California, Los Angeles, PO Box 951736, Los Angeles, CA, 90095, USA. 4. Partners in Hope Medical Centre, PO Box 302, Lilongwe, Malawi. 5. Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, David Geffen School of Medicine, 10833 Le Conte Ave, 37-121 CHS, Los Angeles, California, 90095 USA.
Abstract
OBJECTIVE: To compare one-year outcomes of women started on antiretroviral therapy (ART) during pregnancy in the pre-Option B+ era to those in the Option B+ era. METHODS: A retrospective chart review was performed at three sites in Malawi. Women were included in the 'pre-Option B+' cohort if they started ART during pregnancy for a CD4 count < 350 cells/mm3 or WHO 3/4 condition and in the 'Option B+' cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher's exact and ANOVA F-tests. RESULTS: A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus .5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. CONCLUSIONS: At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.
OBJECTIVE: To compare one-year outcomes of women started on antiretroviral therapy (ART) during pregnancy in the pre-Option B+ era to those in the Option B+ era. METHODS: A retrospective chart review was performed at three sites in Malawi. Women were included in the 'pre-Option B+' cohort if they started ART during pregnancy for a CD4 count < 350 cells/mm3 or WHO 3/4 condition and in the 'Option B+' cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher's exact and ANOVA F-tests. RESULTS: A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus .5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. CONCLUSIONS: At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.
Entities:
Keywords:
antiretroviral therapy; option B+; pregnancy; prevention of mother-to-child transmission
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