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Pregnant Women With HIV Infection Can Expect Healthy Survival: Three-Year Follow-Up

Martin, Fabiola MD*†; Navaratne, Lesley MBBS‡; Khan, Wahid MBChB§; Sarner, Liat MBBS‖; Mercey, Danielle MBChB¶; Anderson, Jane MBBS†; Noble, Heather MBBS‖; Fakoya, Ade MBBS‖; Hawkins, David A MBBS§; Ruiter, Annemiek De MBBS‡; Taylor, Graham P MBChB*#

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 October 2006 - Volume 43 - Issue 2 - pp 186-192
doi: 10.1097/01.qai.0000233311.28602.4d
Clinical Science

Objectives: To document postpartum disease-free survival of HIV-infected women taking antiretroviral therapy (ART) during pregnancy.

Methods: Laboratory and clinical data were collected on all HIV-infected pregnant women delivering from 1998 to 2002 and followed up until September 2004 at 6 hospitals in London. Mothers were grouped according to receipt of zidovudine monotherapy (ZDVm), highly active antiretroviral therapy (HAART) given during and continued after pregnancy (cHAART), and short-term HAART given during pregnancy and discontinued on delivery (START).

Results: Eight-five women took ZDVm, 155 took cHAART, and 71 took START. The mean follow-up for all mothers was 33 months, with a total of 847 person-years. At the first antenatal clinic (ANC) visit, 72% of women were in Centers for Disease Control and Prevention (CDC) stage A, 85% were treatment naive, and the ZDVm group had a median HIV viral load (VL) 10-fold less than those mothers who started HAART during pregnancy. At last follow-up, 1 patient had died and 6 (1.9%) had progressed to CDC stage C; 62% of all women, including a quarter of the ZDVm group, were receiving HAART for their own health; and 83% of all mothers had a VL <50 HIV RNA copies/mL of plasma regardless of whether they were on treatment or not.

Conclusions: The median-term postpartum prognosis of HIV-infected pregnant women with access to HAART is good. Exposure to short-course ZDVm or START during pregnancy did not jeopardize their response to subsequent therapy.

Received for publication October 13, 2005; accepted June 20, 2006.

From *St. Mary's NHS Trust, London, United Kingdom; †Homerton University NHS Trust, London, United Kingdom; ‡Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; §Chelsea and Westminster Hospital, London, United Kingdom; ‖Newham Healthcare NHS Trust, London, United Kingdom; ¶Centre for Sexual Health and HIV Research, University College Hospital, London, United Kingdom; and #Imperial College, London, United Kingdom.

Reprints: Fabiola Martin, Clinical Trials Centre, Winston Churchill Wing, St. Mary's NHS Trust, Praed Street, London, W2 1NY United Kingdom (e-mail: fabiolaaghakhani@yahoo.co.uk).

© 2006 Lippincott Williams & Wilkins, Inc.