title: Predictors of postpartum viral load rebound in a cohort of HIV-infected Brazilian women.
abstract: OBJECTIVE
  To assess the postpartum viral load of HIV-infected women treated with potent antiretrovirals (ARVs) during pregnancy, and look for predictors of viral load rebound.
  
  
  METHODS
  Of 112 women who took potent ARVs during pregnancy, 60 took them as prophylaxis to prevent mother-to-child transmission of HIV. The remaining 52, who had AIDS, were treated continuously with ARVs before, during, and after pregnancy. Viral load was evaluated in the weeks before, just before, and after delivery. Viral load rebound was defined as a 0.5 log(10) increase in viral RNA as measured 6 months after delivery.
  
  
  RESULTS
  A viral load rebound affected women much more often in the prophylaxis than in the treatment group (84.7% vs 15.3%; P<0.001), and was associated with ARV discontinuation. The women with a viral load rebound had a higher decline in CD4 lymphocyte percentage 6 months after delivery. On multivariate analysis, variables positively or negatively associated with a viral load rebound were a decline in CD4 lymphocyte count (P=0.01), the therapeutic use of potent ARVs (P<0.001), and the number of prenatal visits (P=0.03).
  
  
  CONCLUSIONS
  Discontinuing the use of potent ARVs after delivery was associated with a decrease in CD4 lymphocyte count and a viral load rebound.
authors.affiliation: Gynecology and Obstetrics Department, Maternal and Pediatric AIDS Group, School of Medicine, Federal University of Minas Gerais, Brazil.
authors.forename: Ines Katerina
authors.initials: IK
authors.lastname: Cavallo
authors.forename: Fabiana Maria
authors.initials: FM
authors.lastname: Kakehasi
authors.forename: Beatriz Amélia
authors.initials: BA
authors.lastname: Andrade
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Lobato
authors.forename: Regina Amélia
authors.initials: RA
authors.lastname: Aguiar
authors.forename: Jorge Andrade
authors.initials: JA
authors.lastname: Pinto
authors.forename: Victor Hugo
authors.initials: VH
authors.lastname: Melo
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001938:Brazil; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011446:Prospective Studies; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents