title: Progression of HIV disease among women following delivery.
abstract: OBJECTIVE
  To assess patterns of HIV disease progression among HIV-1-infected women following delivery.
  
  
  METHODS
  Four hundred ninety-seven women enrolled in PACTG 185, a phase 3 trial of passive immunoprophylaxis in addition to zidovudine (ZDV) for the prevention of perinatal transmission, were included. Visits occurred twice during pregnancy; at delivery; and at 12, 26, 48, and 78 weeks postpartum. Repeated-measures linear regression and proportional hazards models were applied.
  
  
  RESULTS
  Trial treatment (HIV hyperimmune globulin vs. immune globulin) was not related to postpartum disease progression. Longitudinal analysis of HIV-1 RNA demonstrated stable levels during pregnancy, significantly increased HIV-1 RNA by 12 weeks postpartum even on stable therapy, and a gradual increase thereafter. Changes in CD4+ lymphocyte percentage over 18 months of follow-up were similar for women continuing or stopping ZDV postpartum. Compared with those receiving no therapy, the hazard ratio for AIDS or death among women who received monotherapy postpartum was 0.52 (95% confidence interval [CI]: 0.25-1.04), 0.17 (CI: 0.06-0.49) for women who received combination therapy, and 0.24 (CI: 0.06-1.01) for women who received highly active antiretroviral therapy.
  
  
  CONCLUSIONS
  RNA levels increased significantly from delivery to 12 weeks postpartum. Changes in HIV-1 RNA and CD4+ lymphocyte percentage were similar among women continuing or stopping therapy after delivery, and response to antiretroviral therapy was as expected postpartum.
authors.affiliation: Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA. hw59i@nih.gov
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: John
authors.initials: J
authors.lastname: Lambert
authors.forename: E Richard
authors.initials: ER
authors.lastname: Stiehm
authors.forename: D Robert
authors.initials: DR
authors.lastname: Harris
authors.forename: James
authors.initials: J
authors.lastname: Bethel
authors.forename: Lynne
authors.initials: L
authors.lastname: Mofenson
authors.forename: William A
authors.initials: WA
authors.lastname: Meyer
authors.forename: Bonnie
authors.initials: B
authors.lastname: Mathieson
authors.forename: Mary Glen
authors.initials: MG
authors.lastname: Fowler
authors.forename: George
authors.initials: G
authors.lastname: Nemo
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D015483:HIV Antibodies / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008137:Longitudinal Studies; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000628:therapy* / Q000821:virology; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000032:analysis; D016896:Treatment Outcome; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D015483:HIV Antibodies; C084715:HIV hyperimmune globulin; D016756:Immunoglobulins, Intravenous; D012367:RNA, Viral; D015215:Zidovudine