Pregnancy and HIV disease progression in an early infection cohort from five African countries

• Type of Material: Article
• Authors: Kristin Wall, Emory University; Wasima Rida, Biostatistics Consultant; Lisa Haddad, Emory University; Anatoli Kamali, Medical Research Council/Uganda Virus Research Institute; Etienne Karita, Emory University; Shabir Lakhi, Emory University; William Kilembe, Emory University; Susan Allen, Emory University; Mubiana Inambao, Emory University; Annie H. Yang, Columbia University; Mary H. Latka, The Aurum Institute; Omu Anzala, University of Nairobi; Eduard J. Sanders, University of Oxford; Linda-Gail Bekker, University of Cape Town; Vinodh A. Edward, University of the Witwatersrand; Matt A. Price, University of California San Francisco
• Language: English
• Date: 2016-11-22
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/EDE.0000000000000590
• Title of Journal or Parent Work: Epidemiology
• ISSN: 1044-3983
• Volume: 28
• Issue: 2
• Start Page: 224
• End Page: 232
• Grant/Funding Information: This study was supported by IAVI and made possible by the support of many donors, including the Bill & Melinda Gates Foundation; the Ministry of Foreign Affairs of Denmark; Irish Aid; the Ministry of Finance of Japan in partnership with The World Bank; the Ministry of Foreign Affairs of the Netherlands; the Norwegian Agency for Development Cooperation (NORAD); the United Kingdom Department for International Development (DFID), and the United States Agency for International Development (USAID).; See article for more funding information.
• Keywords: women's health; pregnancy; HIV
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

BACKGROUND:: Understanding associations between pregnancy and HIV disease progression is critical to providing appropriate counseling and care to HIV-positive women. METHODS:: From 2006-2011, women under age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μL, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μL or a single CD4 ≤350 cells/μL followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy. RESULTS:: Among 222 women, 63 experienced clinical progression during 783.5 person-years at-risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR]=0.7;95%CI:0.2-1.8. The association between pregnancy and immunologic progression was aHR=1.7;95%CI:0.9-3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different. CONCLUSIONS:: In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted.