Variation of CD4 Count and Percentage during Pregnancy and after Delivery: Implications for HAART Initiation in Resource-Limited Settings

Postpartum Plasma CD4 Change in HIV-Positive Women: Implications for Timing of HAART Initiation

“…7 Our study showed that CD4 200 and 350 cells=ml cut-off points at delivery correctly identified only 60% (95% CI 47-72) and 61% (95% CI 54-69) of women who had CD4 counts less than the same cut-off at 6 weeks. Of note, our study provides additional information regarding the association between CD4 counts obtained early during the postpartum period and risk of progression of HIV.…”

“…The magnitude of CD4 increase observed between delivery and postpartum was similar to other studies conducted in Africa. [2][3][4]7 In our study, the proportion with CD4 counts <200 and <350 cells=ml at delivery was 15.4% and 39.2%, respectively, and this decreased to 10.2% and 26.7%, respectively, by 6 weeks. Only those who had information on CD4 counts at delivery, 6 weeks, and 12 months are included.…”

“…5,6 A recent publication reported that using CD4 counts at 32 weeks of gestation as HAART eligibility criteria leads to substantial misclassification of HAART eligibility when compared to CD4 values at 1 month postpartum. 7 Using WHO clinical staging and CD4 counts, 28.3% of women in this study were HAART eligible according to their baseline CD4 values whereas only 17.2% were eligible according to their postpartum CD4 values. The authors pointed out that CD4 percentage may be a more accurate indicator of immune status in pregnant and postpartum women than absolute CD4 since the former is less affected by hemodynamic changes associated with pregnancy and postpartum.…”

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

“…Previous studies have evaluated changes in the absolute CD4 + count (Read et al 2007) or percentage (Watts et al 2003) among HIV-infected women who did or did not discontinue ARVs after delivery. As noted previously, the CD4% should be used to monitor T lymphocytes during pregnancy and PP (Miotti et al 1992, Ekouevi et al 2007. In a secondary analysis of the PACTG 185 clinical trial database (Watts et al 2003), women who continued ARV therapy after delivery were compared to those who discontinued therapy.…”

“…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). We analyzed data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI) Perinatal Study to determine factors associated with a VL increase or a CD4% decrease among HIV-infected women who received ARVs during pregnancy, according to whether or not ARVs were discontinued after delivery.…”