Short‐term antiretroviral therapy to prevent mother‐to‐child transmission is safe and results in a sustained increase in CD4 T‐cell counts in HIV‐1‐infected mothers^*

Abstract

BackgroundShort-term antiretroviral therapy (START) to prevent mother-to-child transmission (MTCT) is currently recommended for all HIV-1-infected pregnant women. The objective of this study was to assess the effect on CD4 cell counts and viral load dynamics the withdrawal of START after birth could generate. MethodsThis was a 5-year cohort study involving HIV-1-infected pregnant women who presented with CD4 counts 4300 cells/mL and had received START to prevent MTCT. ResultsSeventy-five pregnancies were assessed. In 24 cases, there was a history of antiretroviral therapy prior to prophylaxis. The median baseline CD4 count was 573 cells/mL. In 75% of cases, prophylaxis was started after 26.6 weeks of gestation. The median CD4 cell count increase over baseline during prophylaxis was 24.5%. In only five cases did HIV-1 viral load remain detectable during prophylaxis. After START, CD4 cell counts did not drop significantly, and the HIV-1 viral load plateau was near the baseline level. The estimated mean time for CD4 count to fall below 300 cells/mL was 3.5 years and was directly associated with high baseline CD4 cell count, as well as with CD4 increase after prophylaxis, whereas it was negatively correlated with previous use of antiretroviral (ARV) drugs and persistence of detectable HIV-1 viral load during prophylaxis. ConclusionsA potent, well-tolerated prophylactic ARV regimen can improve CD4 cell counts during and after START. In women receiving such prophylaxis, there is a remarkable time interval for CD4 cell counts to drop to levels that indicate treatment.

Maternal Outcomes after Haart for the Prevention of Mother-To-Child Transmission in HIV-Infected Women in Brazil

“…This data is consistent with another recent study from Brazil in pregnant women with CD4+ counts > 300 cells/mm 3 on HAART for MTCT, in which it took a mean of 3.5 years for CD4+ counts to fall below 300 cells/mm 3 (16). More durable immune reconstitution was found in those with higher baseline CD4+ and greater CD4+ response to HAART during pregnancy, while more rapid CD4+ decline was associated with prior ARV exposure and detectable viral load during prophylaxis.…”

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].…”

Lower genetic variability of HIV-1 and antiretroviral drug resistance in pregnant women from the state of Pará, Brazil

“…Although the immunological response is physiologically compromised during pregnancy and a decrease in the CD4TL count is usually observed [15], no significant difference was found between the mean value of these cells and the pregnancy stage in the present study, which has also been observed in other studies [16, 17]. …”