title: Consideration of postpartum management in HIV-positive Haitian women: an analysis of CD4 decline, mortality, and follow-up after delivery.
abstract: BACKGROUND
  A previous study at the GHESKIO HIV clinic confirmed that highly active antiretroviral therapy (HAART) prophylaxis reduced mother-to-child transmission (MTCT) and infant mortality in Haiti. This analysis looks at maternal outcomes in this cohort after delivery.
  
  
  METHODS
  Records of 508 HIV-positive Haitian women who delivered between 1999 and 2005 were analyzed. We examined mortality, loss to follow-up, time to death or HAART initiation, and time of decline of CD4 count to 350 cells/μL.
  
  
  RESULTS
  One hundred seventy women reached a CD4 ≤200 or developed clinical AIDS and were started on long-term HAART. The median CD4 count at HAART initiation was 178 (interquartile range, 106-227). CD4 decline was stratified by CD4 at delivery to project the mean months to a CD4 of 350. With an initial CD4 of 350-499 cells/μL, it was 19 months (95% confidence interval: 14 to 28) while with a CD4 >500 cells/μL, it was 71 months (95% confidence interval: 59 to 88). At study close, 257 women remained in follow-up, with loss to follow-up 3 times less in those on HAART (3.2/100 person-years) than those not on HAART (9.8/100 person-years).
  
  
  CONCLUSIONS
  The threshold for starting treatment was often missed in HIV-infected women after delivery. Success of follow-up of women after delivery was favorably influenced by being on HAART. Women with high (>500) initial CD4 counts had a protracted time (5-7 years) before they reach a threshold CD4 count, in contrast to those with CD4 <500 cells/μL. Strategies for postpartum treatment of women should be informed by the speed with which they are likely to progress.
authors: Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors: Alexandra
authors: A
authors: Coria
authors: Francine
authors: F
authors: Noel
authors: Jerry
authors: J
authors: Bonhomme
authors: Vanessa
authors: V
authors: Rouzier
authors: Christian
authors: C
authors: Perodin
authors: Adias
authors: A
authors: Marcelin
authors: Zhongze
authors: Z
authors: Li
authors: Tor D
authors: TD
authors: Tosteson
authors: Marie-Marcelle
authors: MM
authors: Deschamps
authors: Peter F
authors: PF
authors: Wright
authors: Jean W
authors: JW
authors: Pape
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors