Effect of pregnancy on immunological and virological outcomes of women on ART: a prospective cohort study in rural Uganda, 2004-2009.
OBJECTIVE
Before antiretroviral therapy (ART) introduction, pregnancy was associated with a sustained drop in CD4 cell count in HIV-infected women. We examined the effects of pregnancy on immunological and virological ART outcomes.


METHODS
Between January 2004 and March 2009, we studied HIV-infected women receiving ART in a prospective open cohort study in rural Uganda. We used random effects regression models to compare the CD4 counts of women who became pregnant and those who did not, and among the pregnant women before and after pregnancy. CD4 count and proportions with detectable viral load (≥400 copies/ml) were compared between the two groups using the Mann-Whitney rank sum test and logistic regression respectively.


RESULTS
Of 88 women aged 20-40 years receiving ART, 23 became pregnant. At ART initiation, there were no significant differences between those who became pregnant and those who did not in clinical, immunological and virological parameters. Among women who became pregnant, CD4 cell count increased before pregnancy (average 75.9 cells/mm(3) per year), declined during pregnancy (average 106.0) but rose again in the first year after delivery (average 88.6). Among women who did not become pregnant, the average CD4 cell count rise per year for the first 3 years was 88.5. There was no significant difference in the proportions of women with detectable viral load at last clinic visit among those who became pregnant (8.7%) and those who did not (16.1%), P = 0.499.


CONCLUSIONS
Pregnancy had no lasting effect on the immunological and virological outcomes of HIV-infected women on ART.
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. billy.mayanja@mrcuganda.org
Billy N
BN
Mayanja
Leigh Anne
LA
Shafer
Lieve
L
Van der Paal
Nassim
N
Kyakuwa
Nicaise
N
Ndembi
Peter
P
Hughes
Dermot
D
Maher
Heiner
H
Grosskurth
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D018873:Pregnancy Rate; D011446:Prospective Studies; D012424:Rural Population; D018709:Statistics, Nonparametric; D014454:Uganda; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents