Progression of HIV disease among women following delivery

D. Heather Watts, John Lambert, E. Richard Stiehm, D. Robert Harris, James Bethel, Lynne Mofenson, William A. Meyer, Bonnie Mathieson, Mary Glen Fowler, George Nemo

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess patterns of HIV disease progression among HIV-1-infected women following delivery. Methods: Four hundred ninety-seven women enrolled in PACTG 185, a phase 3 trial of passive immunoprophylaxis in addition to zidovudine (ZDV) for the prevention of perinatal transmission, were included. Visits occurred twice during pregnancy; at delivery; and at 12, 26, 48, and 78 weeks postpartum. Repeated-measures linear regression and proportional hazards models were applied. Results: Trial treatment (HIV hyperimmune globulin vs. immune globulin) was not related to postpartum disease progression. Longitudinal analysis of HIV-1 RNA demonstrated stable levels during pregnancy, significantly increased HIV-1 RNA by 12 weeks postpartum even on stable therapy, and a gradual increase thereafter. Changes in CD4+ lymphocyte percentage over 18 months of follow-up were similar for women continuing or stopping ZDV postpartum. Compared with those receiving no therapy, the hazard ratio for AIDS or death among women who received monotherapy postpartum was 0.52 (95% confidence interval [CI]: 0.25-1.04), 0.17 (CI: 0.06-0.49) for women who received combination therapy, and 0.24 (CI: 0.06-1.01) for women who received highly active antiretroviral therapy. Conclusions: RNA levels increased significantly from delivery to 12 weeks postpartum. Changes in HIV-1 RNA and CD4+ lymphocyte percentage were similar among women continuing or stopping therapy after delivery, and response to antiretroviral therapy was as expected postpartum.

Original languageEnglish (US)
Pages (from-to)585-593
Number of pages9
JournalJournal of acquired immune deficiency syndromes
Volume33
Issue number5
DOIs
StatePublished - Aug 15 2003
Externally publishedYes

Keywords

  • Disease progression
  • HIV
  • Pregnancy

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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