Skip Navigation LinksHome > August 15, 2012 - Volume 60 - Issue 5 > Prevalent Pregnancy, Biological Sex, and Virologic Response...
JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e318256b310
Epidemiology and Prevention

Prevalent Pregnancy, Biological Sex, and Virologic Response to Antiretroviral Therapy

Westreich, Daniel PhD*; Evans, Denise PhD†,‡; Firnhaber, Cindy MD, MS†,§; Majuba, Pappie MBChB§; Maskew, Mhairi MBBCh, MSc†,‡

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Objective: Pregnancy is a common indication for initiation of highly active antiretroviral therapy (HAART) in sub-Saharan Africa. Our objective was to evaluate how pregnancy at treatment initiation predicts virologic response to HAART.

Methods: We evaluated an open cohort of 9173 patients who initiated HAART between April 2004 and September 2009 in the Themba Lethu Clinic in Johannesburg, South Africa. Risk ratios were estimated using log-binomial regression; hazard ratios were estimated using Cox proportional hazards models; time ratios were estimated using accelerated failure time models. We controlled for calendar date, age, ethnicity, employment status, history of smoking, tuberculosis, WHO stage, weight, body mass index, hemoglobin, CD4 count and CD4 percent, and whether clinical care was free. Extensive sensitivity and secondary analyses were performed.

Results: During follow-up, 822 nonpregnant women and 70 pregnant women experienced virologic failure. In adjusted analyses, pregnancy at baseline was associated with reduced risk of virologic failure by 6 months [risk ratio 0.66, 95% confidence limits (CL): 0.35 to 1.22] and with reduced hazard of virologic failure over follow-up (hazard ratio: 0.69, 95% CL: 0.50 to 0.95). The adjusted time ratio for failure was 1.44 (95% CL: 1.13 to 1.84), indicating 44% longer time to event among women pregnant at baseline. Sensitivity analyses generally confirmed main findings.

Conclusions: Pregnancy at HAART initiation is not associated with increased risk of virologic failure at 6 months or during longer follow-up.

© 2012 Lippincott Williams & Wilkins, Inc.


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