Progression of HIV disease among women following delivery.
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.
Watts
D Heather
DH
Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA. hw59i@nih.gov
Lambert
John
J
Stiehm
E Richard
ER
Harris
D Robert
DR
Bethel
James
J
Mofenson
Lynne
L
Meyer
William A
WA
Mathieson
Bonnie
B
Fowler
Mary Glen
MG
Nemo
George
G
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
D019380:Anti-HIV Agents; D015483:HIV Antibodies; C084715:HIV hyperimmune globulin; D016756:Immunoglobulins, Intravenous; D012367:RNA, Viral; D015215:Zidovudine