Pregnant Women With HIV Infection Can Expect Healthy Survival

Martin, Fabiola; Navaratne, Lesley; Khan, Wahid Ali; Sarner, Liat; Mercey, D; Anderson, Jane; Noble, Heather; Fakoya, Ade; Hawkins, David; Ruiter, Annemiek de; Taylor, Graham P.

doi:10.1097/01.qai.0000233311.28602.4d

Cited by 28 publications

(30 citation statements)

References 18 publications

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“…Similar findings have been reported elsewhere. 17 The most significant finding from this study was the low rate of HIV follow-up care after delivery. Only 37% of these women had two or more documented visits with an HIV provider in 1 year, which is less frequent than what is recommended as the standard of longitudinal care.…”

Section: Discussionmentioning

confidence: 74%

Follow-Up Care Among HIV-Infected Pregnant Women in Mississippi

Rana

Gillani

Flanigan

et al. 2010

Journal of Women's Health

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Background: Data from the Centers for Disease Control and Prevention (CDC) indicate that reproductive-age black women in the Southeast are disproportionately affected by the HIV epidemic. There are few data describing HIV infection, pregnancies, and follow-up care in this population. Methods: A retrospective chart review was performed at the Perinatal HIV Service at the University of Mississippi Medical Center in Jackson, Mississippi, to identify HIV-infected women 18 years of age with deliveries from 1999 to 2006. Optimal follow-up was defined as at least two follow-up visits with an HIV provider within 1 year of delivery. Univariate and multivariate logistic regression analyses were used to identify factors associated with optimal adherence. Results: We identified 274 women with 297 total deliveries. Median age was 25, and 89% were black. Only 37% of women had two or more visits with an HIV provider in the postpartum year. On univariate analysis, presentation before the third trimester was associated with optimal follow-up ( p ¼ 0.04). On multivariate analyses, presentation before the third trimester was the only variable associated with optimal follow-up (odds ratio [OR] 2.1, p ¼ 0.02). Conclusions: The poor follow-up rates in this growing population highlight the critical need for research and development of targeted interventions to improve rates of retention in care, particularly in women with late trimester presentation.

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Section: Discussionmentioning

confidence: 74%

Follow-Up Care Among HIV-Infected Pregnant Women in Mississippi

Rana

Gillani

Flanigan

et al. 2010

Journal of Women's Health

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“…Similarly, other studies have assessed VL changes among HIV-infected women according to the continuation or discontinuation of ARVs after delivery (Cao et al 1997, Melvin et al 1997, Watts et al 2003, Martin et al 2006, Tungsiripat et al 2007. Some studies have suggested no change in VL PP, although others indicated VL increases.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

mentioning

confidence: 99%

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

Melo

Pinto

Freimanis-Hance

et al. 2011

Mem. Inst. Oswaldo Cruz

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Section: Discussionmentioning

confidence: 99%

“…These studies included women who received mono-or dual-NRTI therapy during pregnancy, 16 did not assess for non-HIV outcomes, 16,17 and had shorter study periods. 18 These studies showed that women discontinuing ART postpartum either had an increased risk of progression to ADE or death, 16 no difference in progression to ADE or death, 17 or increased risk of class B events. 18 HAART use in our cohort was similar to the use in another study in a resource-rich setting over comparable period of time 19 : PI-based HAART regimen use increased and NNRTIand NRTI-based HAART regimen use decreased during the study period.…”

Section: Discussionmentioning

confidence: 99%

Postpartum Discontinuation of Antiretroviral Therapy and Risk of Maternal AIDS-Defining Events, Non-AIDS–Defining Events, and Mortality Among a Cohort of HIV-1–Infected Women in the United States

Melekhin

Shepherd

Jenkins

et al. 2010

AIDS Patient Care and STDs

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This retrospective cohort study of HIV-infected women receiving highly active antiretroviral therapy (HAART) while pregnant assessed the effect of postpartum HAART discontinuation on maternal AIDS-defining events (ADEs), non-AIDS-defining events (non-ADEs), and death 1997-2008 in Nashville, Tennessee. Cox proportional hazards models compared rates of ADE or all-cause death and non-ADE or all-cause death, and competing risks analyses compared rates of ADE or ADE-related death and non-ADE or non-ADE-related death across the groups. There were two groups: women who stopped HAART postpartum (discontinuation, n ¼ 54) and women who continued HAART postpartum (continuation, n ¼ 69). Fifty percent were African American, 40% had prior non-HAART antiretroviral therapy (ART) use, and 38% had a history of illicit drug use. Median age was 27.5 years, baseline CD4(%) was 532 (34%) and CD4 nadir was 332 cells=mm 3 , baseline and peak HIV-1 RNA were 2.6 and 4.32 log 10 copies per milliliter, respectively. Women in the continuation group were older, had lower baseline CD4, CD4%, and CD4 nadir, and had higher peak HIV-1 RNA. In multivariable proportional hazards models, the hazard ratios [95% confidence interval (CI)] of ADE or all-cause death and non-ADE or all-cause death were lower in the continuation group, but not statistically significantly: 0.50 (0.12, 2.12; p ¼ 0.35) and 0.69 (0.24, 1.95; p ¼ 0.48), respectively. The results were similar in competing risks analyses. Despite having characteristics associated with worse prognosis, women who continued HAART postpartum had lower hazard ratio point estimates for ADEs or death and non-ADEs or death than women who discontinued HAART. Larger studies with longer follow-up are indicated to assess this association.

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Pregnant Women With HIV Infection Can Expect Healthy Survival

Abstract: The median-term postpartum prognosis of HIV-infected pregnant women with access to HAART is good. Exposure to short-course ZDVm or START during pregnancy did not jeopardize their response to subsequent therapy.

Cited by 28 publications

References 18 publications

Follow-Up Care Among HIV-Infected Pregnant Women in Mississippi

Follow-Up Care Among HIV-Infected Pregnant Women in Mississippi

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

Postpartum Discontinuation of Antiretroviral Therapy and Risk of Maternal AIDS-Defining Events, Non-AIDS–Defining Events, and Mortality Among a Cohort of HIV-1–Infected Women in the United States

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