title: Postpartum discontinuation of antiretroviral therapy and risk of maternal AIDS-defining events, non-AIDS-defining events, and mortality among a cohort of HIV-1-infected women in the United States.
abstract: This retrospective cohort study of HIV-infected women receiving highly active antiretroviral therapy (HAART) while pregnant assessed the effect of postpartum HAART discontinuation on maternal AIDS-defining events (ADEs), non-AIDS-defining events (non-ADEs), and death 1997-2008 in Nashville, Tennessee. Cox proportional hazards models compared rates of ADE or all-cause death and non-ADE or all-cause death, and competing risks analyses compared rates of ADE or ADE-related death and non-ADE or non-ADE-related death across the groups. There were two groups: women who stopped HAART postpartum (discontinuation, n = 54) and women who continued HAART postpartum (continuation, n = 69). Fifty percent were African American, 40% had prior non-HAART antiretroviral therapy (ART) use, and 38% had a history of illicit drug use. Median age was 27.5 years, baseline CD4(%) was 532 (34%) and CD4 nadir was 332 cells/mm(3), baseline and peak HIV-1 RNA were 2.6 and 4.32 log(10) copies per milliliter, respectively. Women in the continuation group were older, had lower baseline CD4, CD4%, and CD4 nadir, and had higher peak HIV-1 RNA. In multivariable proportional hazards models, the hazard ratios [95% confidence interval (CI)] of ADE or all-cause death and non-ADE or all-cause death were lower in the continuation group, but not statistically significantly: 0.50 (0.12, 2.12; p = 0.35) and 0.69 (0.24, 1.95; p = 0.48), respectively. The results were similar in competing risks analyses. Despite having characteristics associated with worse prognosis, women who continued HAART postpartum had lower hazard ratio point estimates for ADEs or death and non-ADEs or death than women who discontinued HAART. Larger studies with longer follow-up are indicated to assess this association.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. vlada.melekhin@vanderbilt.edu
authors.forename: Vlada V
authors.initials: VV
authors.lastname: Melekhin
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Stinnette
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.forename: Sally S
authors.initials: SS
authors.lastname: Bebawy
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Rasbach
authors.forename: Todd
authors.initials: T
authors.lastname: Hulgan
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D015996:Survival Rate; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral