Predictors of postpartum viral load rebound in a cohort of HIV-infected Brazilian women.
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.
Cavallo
Ines Katerina
IK
Gynecology and Obstetrics Department, Maternal and Pediatric AIDS Group, School of Medicine, Federal University of Minas Gerais, Brazil.
Kakehasi
Fabiana Maria
FM
Andrade
Beatriz Amélia
BA
Lobato
Ana Cristina
AC
Aguiar
Regina Amélia
RA
Pinto
Jorge Andrade
JA
Melo
Victor Hugo
VH
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
D044966:Anti-Retroviral Agents