Predictors of postpartum viral load rebound in a cohort of HIV‐infected Brazilian women

Abstract

Discontinuing the use of potent ARVs after delivery was associated with a decrease in CD4 lymphocyte count and a viral load rebound.

Maternal CD4+ Cell Count Decline after Interruption of Antiretroviral Prophylaxis for the Prevention of Mother-to-Child Transmission of HIV

“…Similar to our findings, 20% of 75 HIV+ pregnant women in a Brazilian cohort with similar immunologic status (median CD4+ 573 cells/mm 3 ) who initiated tARVp had CD4+ decline to <300 cells/mm 3 within 24 months after discontinuing prophylaxis [12]. Comparisons of CD4+ decline among women who either discontinued tARVp at delivery or continued have yielded conflicting results: over a short follow-up period of 6 months postpartum, women who discontinued tARVp had a higher rate of decline compared to women who continued ART regimens in a Brazilian cohort [13]. In contrast, Watts and colleagues in the US found no difference in the rate of decline in CD4+ over a longer follow-up period, 12 months postpartum, among women who discontinued prophylaxis compared to those who continued regimens, even after stratifying by prophylaxis regimen (scARVp or AZT monotherapy).…”

HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods

“…Some data suggest that women on ART for their own health may be more adherent than women taking ARVs for prophylaxis [6], however other studies suggest adherence challenges for this group. Among women initiated on ART during pregnancy in South Africa, 49% of women missed a visit or disengaged from care by six months postpartum [7].…”

Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

“…In addition, there was a higher decline in CD4 cell percentage among women in the PR group at this time (Cavallo et al 2010).…”

“…Data collected from a small part of the current cohort (4% of the study population) has been published elsewhere (Cavallo et al 2010). …”

“…The results of studies evaluating changes in the plasma HIV RNA concentration [viral load (VL)], the CD4 + lymphocyte percentage (CD4%) or absolute CD4 + lymphocyte count, or the HIV clinical disease stage in the postpartum (PP) period among HIV-infected women continuing or discontinuing ARVs after pregnancy have shown conflicting results (Cao et al 1997, Melvin et al 1997, Watts et al 2003, Martin et al 2006, Tungsiripat et al 2007, Cavallo et al 2010. To avoid the effect of a higher volume of distribution on absolute CD4 + lymphocyte counts, the CD4% should be used for monitoring T lymphocytes during pregnancy and PP (Miotti et al 1992, Ekouevi et al 2007).…”