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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
HIV disease progression in the first year after delivery among african women followed in the HPTN 046 clinical trial
Journal of Acquired Immune Deficiency Syndromes, Volume 64, No. 3, Year 2013
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Description
BACKGROUND: Starting lifelong antiretroviral therapy (ART) in HIV-infected pregnant women may decrease HIV progression and transmission, but adherence after delivery may be difficult, especially for asymptomatic women. We evaluated disease progression among HIV-infected women not on ART with CD4 lymphocyte counts above 200 cells per microliter at delivery. METHODS: We analyzed risk of death, progression to AIDS (stage IV or CD4 < 200 cells per microliter), or to CD4 count <350 1 year after delivery among postpartum women enrolled to a prevention of breastfeeding transmission trial using the Kaplan-Meier method. In the primary analysis, women were censored if ART was initiated. RESULTS: Among 1285 women who were not WHO stage IV or less at 6 weeks postpartum, 49 (4.3%) progressed to stage IV/CD4 <200 cells per microliter or death by 1 year. Progression to CD4 <200 cells per microliter or death occurred among 16 (4.3%) of 441 women with CD4 count of 350-549 cells per microliter and 10 (1.6%) of 713 with CD4 counts >550 cells per microliter at delivery. CD4 <350 cells per microliter by 12 months postpartum occurred among 116 (37.0%) of 350 women with CD4 count 400-549 cells per microliter and 48 (7.4%) of 713 with CD4 count >550 cells per microliter at delivery. CONCLUSIONS: Progression to AIDS or CD4 count <350 cells per microliter is uncommon through 1 year postpartum for women with CD4 counts over 550 cells per microliter at delivery, but occurred in over one third of those with CD4 counts under 550 cells per microliter. ART should be continued after delivery or breastfeeding among women with CD4 counts <550 cells per microliter if follow-up and antiretroviral adherence can be maintained. Copyright © 2013 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Watts, Diane Heather
United States, Bethesda
National Institute of Child Health and Human Development Nichd
South Africa, Johannesburg
University of the Witwatersrand
Brown, Elizabeth R.
United States, Seattle
Fred Hutchinson Cancer Research Center
Maldonado, Yvonne Aida
United States, Stanford
Stanford University School of Medicine
Herron, Casey
United States, Seattle
Fred Hutchinson Cancer Research Center
Chipato, Tsungai
Zimbabwe, Harare
University of Zimbabwe
Reddy, Leanne
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Moodley, Dhayendre
South Africa, Congella
Centre for the Aids Programme of Research in South Africa
Nakabiito, Clemensia
United States, Baltimore
Johns Hopkins University
Manji, Karim Premji
India
Muhimbili University of Health and Allied Sciences
Fawzi, Wafaie W.
United States, Boston
Harvard T.h. Chan School of Public Health
George, Kathleen H.
United States, Durham
Fhi 360
Richardson, Paul A.
United States, Baltimore
Johns Hopkins Medical Institutions
Zwerski, Sheryl L.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
South Africa, Johannesburg
University of the Witwatersrand
Coovadia, Hoosen Mahomed
United States, Seattle
Statistical Center for Hiv/aids Research and Prevention Scharp
Fowler, Mary Glenn
United States, Baltimore
Johns Hopkins Medical Institutions
Statistics
Citations: 15
Authors: 15
Affiliations: 13
Identifiers
Doi:
10.1097/QAI.0b013e3182a2123a
ISSN:
15254135
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Participants Gender
Female