title: Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002-2009.
abstract: OBJECTIVE
  To describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts.
  
  
  METHODS
  A prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6 months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling.
  
  
  RESULTS
  Antiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P<0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P<0.001). The proportion of women with viral loads below 1000 copies/mL at hospital discharge after delivery (HD) increased over time (P=0.0031). Median CD4 lymphocyte counts also rose at HD, from 441 cell/mm(3) to 515 cells/mm(3) (P<0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P=0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%).
  
  
  CONCLUSIONS
  The results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region.
authors.affiliation: Health Studies Sector, Westat, 1600 Research Blvd, Rockville, MD 20850, USA. soniastoszek@westat.com
authors.forename: Sonia K
authors.initials: SK
authors.lastname: Stoszek
authors.forename: Geraldo
authors.initials: G
authors.lastname: Duarte
authors.forename: Laura Freimanis
authors.initials: LF
authors.lastname: Hance
authors.forename: Jorge
authors.initials: J
authors.lastname: Pinto
authors.forename: Maria I
authors.initials: MI
authors.lastname: Gouvea
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Cohen
authors.forename: Breno
authors.initials: B
authors.lastname: Santos
authors.forename: Elizabete
authors.initials: E
authors.lastname: Teles
authors.forename: Regina
authors.initials: R
authors.lastname: Succi
authors.forename: Jorge O
authors.initials: JO
authors.lastname: Alarcon
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017691:Caribbean Region; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007843:Latin America; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents