Mode of delivery and postpartum HIV-1 disease progression: the Women and Infants Transmission Study.
OBJECTIVE
To assess the relationship between mode of delivery and subsequent maternal HIV-1 disease progression.


METHODS
Changes in CD4+ lymphocyte percentage (CD4%) and plasma HIV-1 RNA concentration (HIV RNA), and time to progression to AIDS or death among HIV-1-infected women were compared according to mode of delivery [cesarean section before labor and ruptured membranes (SCS), cesarean section after labor and/or after ruptured membranes (NSCS), and vaginal delivery]. Generalized estimating equations were used to compare changes in adjusted mean CD4% and HIV RNA counts by mode of delivery. Cox proportional hazard models were used to assess differences in time to AIDS or death.


RESULTS
In adjusted analyses, there were no clinically important differences in HIV-1 disease progression according to mode of delivery (SCS, n = 183; NSCS, n = 221; vaginal, n = 1087), as assessed by changes in CD4% and HIV RNA during the 18 months following delivery, and by progression to AIDS or death during a mean postpartum follow-up of 2.66 years.


CONCLUSIONS
The present results suggest that, among HIV-1-infected women in North America, mode of delivery is not associated with subsequent HIV-1 disease progression.
Navas-Nacher
Elena L
EL
Children's Memorial Medical Center, Chicago, Illinois, USA.
Read
Jennifer S
JS
Leighty
Robert M
RM
Tuomala
Ruth E
RE
Zorrilla
Carmen D
CD
Landesman
Sheldon
S
Rosenblatt
Howard
H
Hershow
Ronald C
RC
D000328:Adult; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology; D011644:Puerperal Disorders / Q000276:immunology / Q000821:virology*; D012367:RNA, Viral
D012367:RNA, Viral