title: Prevalent pregnancy, biological sex, and virologic response to antiretroviral therapy.
abstract: OBJECTIVE
  Pregnancy is a common indication for initiation of highly active antiretroviral therapy (HAART) in sub-Saharan Africa. Our objective was to evaluate how pregnancy at treatment initiation predicts virologic response to HAART.
  
  
  METHODS
  We evaluated an open cohort of 9173 patients who initiated HAART between April 2004 and September 2009 in the Themba Lethu Clinic in Johannesburg, South Africa. Risk ratios were estimated using log-binomial regression; hazard ratios were estimated using Cox proportional hazards models; time ratios were estimated using accelerated failure time models. We controlled for calendar date, age, ethnicity, employment status, history of smoking, tuberculosis, WHO stage, weight, body mass index, hemoglobin, CD4 count and CD4 percent, and whether clinical care was free. Extensive sensitivity and secondary analyses were performed.
  
  
  RESULTS
  During follow-up, 822 nonpregnant women and 70 pregnant women experienced virologic failure. In adjusted analyses, pregnancy at baseline was associated with reduced risk of virologic failure by 6 months [risk ratio 0.66, 95% confidence limits (CL): 0.35 to 1.22] and with reduced hazard of virologic failure over follow-up (hazard ratio: 0.69, 95% CL: 0.50 to 0.95). The adjusted time ratio for failure was 1.44 (95% CL: 1.13 to 1.84), indicating 44% longer time to event among women pregnant at baseline. Sensitivity analyses generally confirmed main findings.
  
  
  CONCLUSIONS
  Pregnancy at HAART initiation is not associated with increased risk of virologic failure at 6 months or during longer follow-up.
authors.affiliation: Department of Obstetrics and Gynecology and Duke Global Health Institute, Duke University, Durham, NC 27710, USA. daniel.westreich@duke.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.forename: Denise
authors.initials: D
authors.lastname: Evans
authors.forename: Cindy
authors.initials: C
authors.lastname: Firnhaber
authors.forename: Pappie
authors.initials: P
authors.lastname: Majuba
authors.forename: Mhairi
authors.initials: M
authors.lastname: Maskew
mesh_terms: D000328:Adult; D000349:Africa; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D013019:South Africa; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents