Postpartum plasma CD4 change in HIV-positive women: implications for timing of HAART initiation.
CD4 counts increase during the postpartum period and may not correctly identify HAART-eligible HIV-positive women. HAART eligibility when defined by two CD4 cutoffs (<200 and <350 cells/microl) measured at two time points (within 96 h of delivery and 6 weeks) in postpartum HIV-positive women was compared. Among HIV-positive women who had CD4 at delivery and 6 weeks (n = 423), time to Stage 3 or 4 opportunistic infection or death was compared using Cox regression between three groups of women: (1) CD4 <200 cells/microl at delivery and 6 weeks, (2) CD4 <200 cells/microl at delivery but >or=200 cells/microl at 6 weeks, and (3) CD4 >or=200 cells/microl at delivery and at 6 weeks. The analysis was repeated using the CD4 <350 cells/microl cut-off. CD4 counts increased by a median (IQR) of 70 (1-178) cells/microl between delivery and 6 weeks and decreased thereafter to approximately delivery levels at 12 months. Only 60% and 61% who had CD4 <200 cells/microl and CD4 <350 cells/microl, respectively, at delivery also had those levels at 6 weeks. Among those with CD4 <350 cells/microl at both delivery and 6 weeks, the risk of death or Stage 3 or 4 disease was 5.27 (95% CI 1.85-14.96) times higher than those with CD4 <350 at delivery but >or=350 cells/microl at 6 weeks. The use of CD4 counts immediately postpartum to define HAART eligibility may lead to substantial misclassification.
Koyanagi
Ai
A
Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA.
Ruff
Andrea J
AJ
Moulton
Lawrence H
LH
Ntozini
Robert
R
Mutasa
Kuda
K
Iliff
Peter
P
Humphrey
Jean H
JH
D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D036861:Delivery, Obstetric; D004334:Drug Administration Schedule; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007231:Infant, Newborn; D049590:Postpartum Period / Q000276:immunology*; D013997:Time Factors; D015030:Zimbabwe
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