Variation of CD4 count in pregnant women living with HIV

Byrns, Michelle; Elwood, Chelsea; Capmas, P.; Kakkar, Fatima; Boucher, Marc; Money, Deborah; Boucoiran, Isabelle

doi:10.1016/j.ajog.2020.08.122

Cited by 4 publications

(2 citation statements)

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“…The CD4 drop in pregnancy (about 50 cells) is not a real reduction in CD4 cells but the same amount in a larger amount of blood due to hemodilution. The drop is only temporary, which is more in the first trimester of pregnancy and in primigravidae [ 19 ]. In this study, we calculated variation in CD4 cell counts from the first ANC visit, on what he median (IQR) gestational age at ANC enrolment was 21 [ 15 – 25 ] weeks, therefore, after the first trimester of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Nhampossa

González

Nhacolo

et al. 2022

BMC Pregnancy Childbirth

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Background Information on the frequency and clinical features of advanced HIV disease (AHD) in pregnancy and its effects on maternal and perinatal outcomes is limited. The objective of this study was to describe the prevalence and clinical presentation of AHD in pregnancy, and to assess the impact of AHD in maternal and perinatal outcomes in Mozambican pregnant women. Methods This is a prospective and retrospective cohort study including HIV-infected pregnant women who attended the antenatal care (ANC) clinic at the Manhiça District Hospital between 2015 and 2020. Women were followed up for 36 months. Levels of CD4 + cell count were determined to assess AHD immune-suppressive changes. Risk factors for AHD were analyzed and the immune-suppressive changes over time and the effect of AHD on pregnancy outcomes were assessed. Results A total of 2458 HIV-infected pregnant women were enrolled. The prevalence of AHD at first ANC visit was 14.2% (349/2458). Among women with AHD at enrolment, 76.2% (260/341) were on antiretroviral therapy (ART). The proportion of women with AHD increased with age reaching 20.5% in those older than 35 years of age (p < 0.001). Tuberculosis was the only opportunistic infection diagnosed in women with AHD [4.9% (17/349)]. There was a trend for increased CD4 + cell count in women without AHD during the follow up period; however, in women with AHD the CD4 + cell count remained below 200 cells/mm3 (p < 0.001). Forty-two out of 2458 (1.7%) of the women were severely immunosuppressed (CD4 + cell count < 50 cells/mm3). No significant differences were detected between women with and without AHD in the frequency of maternal mortality, preterm birth, low birth weight and neonatal HIV infection. Conclusions After more than two decades of roll out of ART in Mozambique, over 14% and nearly 2% of HIV-infected pregnant women present at first ANC clinic visit with AHD and severe immunosuppression, respectively. Prompt HIV diagnosis in women of childbearing age, effective linkage to HIV care with an optimal ART regimen and close monitoring after ART initiation may contribute to reduce this burden and improve maternal and child survival.

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Section: Discussionmentioning

confidence: 99%

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Nhampossa

González

Nhacolo

et al. 2022

BMC Pregnancy Childbirth

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show abstract

“…The CD4 drop in pregnancy (about 50 cells) is not a real reduction in CD4 cells but the same amount in a larger amount of blood. The drop is only temporary, which is more in the rst trimester of pregnancy and in primigravidae (19). In this study, we calculated variation in CD4 cell counts from the rst ANC visit, on what he median (IQR) gestational age at ANC enrolment was 21 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) weeks, therefore, after the rst trimester of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Nhampossa

González

Nhacolo

et al. 2022

Preprint

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Background: Information on the frequency and clinical features of advanced HIV disease (AHD) in pregnancy and its effects on maternal and perinatal outcomes is limited. The objective of this study was to describe the prevalence and clinical presentation of AHD in pregnancy, and to assess the impact of AHD in maternal and perinatal outcomes in Mozambican pregnant women.Methods: This is a prospective and retrospective cohort study including HIV-infected pregnant women who attended the antenatal care (ANC) clinic at the Manhiça District Hospital between 2015 and 2020. Women were followed up for 36 months. Levels of CD4+ cell count were determined to assess AHD immune-suppressive changes. Risk factors for AHD were analyzed and the immune-suppressive changes over time and the effect of AHD on pregnancy outcomes were assessed. Results: A total of 2458 HIV-infected pregnant women were enrolled. The prevalence of AHD at first ANC visit was 14.2% (349/2458). Among women with AHD at enrolment, 76.2% (260/341) were on antiretroviral therapy (ART). The proportion of women with AHD increased with age reaching 20.5% in those older than 35 years of age (p<0.001). Tuberculosis was the only opportunistic infection diagnosed in women with AHD [4.9% (17/349)]. There was a trend for increased CD4+ cell count in women with and without AHD during the follow up period; however, in women with AHD the CD4+ cell count remained below 200 cells/mm³ (p<0.001). Forty-two out of 2458 (1.7%) of the women were severely immunosuppressed (CD4+cell count<50 cells/mm3). Maternal mortality was higher in women with AHD [1.1% (4/349)] versus [0.5% (11/2109]. There were no differences between women with and without AHD in the frequency of prematurity, low birth weight and neonatal HIV infection. Conclusions: After more than two decades of roll out of ART in Mozambique, over 14% and nearly 2% of HIV-infected pregnant women present at first ANC clinic visit with AHD and severe immunosuppression, respectively. Prompt HIV diagnosis in women of childbearing age, effective linkage to HIV care and close monitoring after ART initiation may contribute to reduce this burden and improve maternal and child survival.

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Guideline No. 450: Care of Pregnant Women Living with HIV and Interventions to Reduce Perinatal Transmission

Atkinson,

Tulloch,

Boucoiran

et al. 2024

Journal of Obstetrics and Gynaecology Canada

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Variation of CD4 count in pregnant women living with HIV

Cited by 4 publications

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Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Burden, clinical presentation and risk factors of advanced HIV disease in pregnant Mozambican women

Guideline No. 450: Care of Pregnant Women Living with HIV and Interventions to Reduce Perinatal Transmission

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