Mortality among HIV-positive postpartum women   with high CD4 cell counts in Zimbabwe.
BACKGROUND
Whereas HAART initiated at CD4 cell counts 351-450 cells/ml reduces mortality, compared with starting at lower CD4 levels, there is currently no evidence for the advantages of initiating treatment at CD4 cell counts greater than 450 cells/ml.


METHODS
Mortality hazard, as a function of CD4 cell count, was estimated among postpartum HIV-positive women in Zimbabwe, using HIV-negative women as the reference group.


RESULTS
Mortality within 24 months postpartum was 54 times higher among women with CD4 cell counts less than 200 cells/ml, fell to 5.4 times higher for those with CD4 cell counts 400-600 cells/ml but fell little thereafter. For CD4 cell counts greater than 600 cells/ml the hazard was 6.2 (95% confidence interval 3.2-11.9).


CONCLUSIONS
Early HAART initiation for all HIV-positive pregnant women may benefit individual mothers and infants, and simultaneously reduce population HIV incidence.
Hargrove
John W
JW
DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa.
Humphrey
Jean H
JH
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011379:Prognosis; D012367:RNA, Viral; D019562:Viral Load; D015030:Zimbabwe / Q000453:epidemiology
D012367:RNA, Viral