Initiation of antiretroviral therapy among pregnant women in resource-limited countries: CD4+ cell count response and program retention.

OBJECTIVE(S): Few data are available from resource-limited countries on long-term outcomes of HIV-infected women who initiate antiretroviral therapy (ART) during pregnancy.

DESIGN

Analysis of data from adult patients enrolled in the MTCT-Plus Initiative who initiated ART between 2003 and 2006 in seven countries in Sub-Saharan Africa and Thailand.

METHODS

Mean population changes were assessed and multivariable mixed linear regression modeling was used to examine covariate effects on differences in absolute CD4 cell count responses. Kaplan-Meier methods were used to examine program retention combining survival and losses to follow-up.

RESULTS

Of 2229 individuals initiating ART, 1688 were women, of which 605 were pregnant (median gestational age 7 months), 1083 were not pregnant, and 541 were men. The average CD4 response by 30 months on ART was 451 cells/microl among women who were pregnant at ART initiation as compared with 435 cells/microl among nonpregnant women (P = 0.53) and 349 cells/microl among men (P < 0.001). In multivariable analysis, lower CD4 cell increase was independently associated with male sex, older age, and lower CD4 cell count at initiation. After 30 months on ART retention was 0.85 with no retention differences between pregnant women, nonpregnant women, and men.

CONCLUSION

HIV-infected women in resource-limited countries who start ART during pregnancy have similar or better long-term CD4 cell count responses as compared with other adults. These data support efforts to provide pregnant HIV-infected women with access to ART in resource-limited countries.