title: Maternal outcomes after HAART for the prevention of mother-to-child transmission in HIV-infected women in Brazil.
abstract: BACKGROUND
  Information is lacking on outcomes in HIV-infected Brazilian women with CD4(+) T-cell counts >200 cells/mm(3) who initiate HAART for the prevention of mother-to-child transmission, and discontinue after delivery.
  
  
  METHODS
  Clinical event rates after postpartum HAART discontinuation were calculated for all WHO stage 2-3 events, as well as for HIV progression warranting HAART re-initiation, defined by a WHO stage 4 event and/or CD4(+) T-cell decrease to ≤200 cells/mm(3). Predictors of the WHO stage 2-3 events and HIV progression outcomes were evaluated with Cox's proportional hazards models.
  
  
  RESULTS
  A total of 120 women were followed for a mean of 1.5 years after delivery. Overall, 26 women had 30 events as follows: 20 developed WHO stage 2-3 events, yielding an incidence rate of 13/100 person-years (PY; 95% CI 8-20); 10 developed HIV progression requiring HAART re-initiation (incidence ratio 6/100 PY, 95% CI 3-11). Among progressors, a single woman developed a WHO stage 4 clinical event and the remainder had CD4(+) T-cell decreases. Women who had baseline CD4(+) T-cell counts between 200-500 cells/mm(3) had a hazard ratio for WHO stage 2-3 events of 2.5 compared to women with baseline ≥500 cells/mm(3) (95% CI 1.0-6.3; P=0.05). The only significant predictor of HIV progression was baseline CD4(+) T-cell count (hazard ratio 0.99, 95% CI 0.98-0.99; P=0.02).
  
  
  CONCLUSIONS
  In this observational study, a baseline CD4(+) T-cell count <500 cells/mm(3) was associated with an increased risk of postpartum WHO stage 2-3 clinical events and HIV disease progression. Randomized studies are needed to further evaluate the effect of postpartum treatment discontinuation on maternal health.
authors.affiliation: Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, Brazil.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Pilotto
authors.forename: Luciane S
authors.initials: LS
authors.lastname: Velasque
authors.forename: Ruth K
authors.initials: RK
authors.lastname: Friedman
authors.forename: Ronaldo I
authors.initials: RI
authors.lastname: Moreira
authors.forename: Valdilea G
authors.initials: VG
authors.lastname: Veloso
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.forename: Mariza G
authors.initials: MG
authors.lastname: Morgado
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
authors.forename: Risa M
authors.initials: RM
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D001938:Brazil; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents