title: Biomarkers from late pregnancy to 6 weeks postpartum in HIV-infected women who continue versus discontinue antiretroviral therapy after delivery.
abstract: BACKGROUND
  Women who use antiretroviral therapy (ART) solely for the prevention of mother-to-child transmission of HIV discontinue postpartum. We hypothesized that women discontinuing ART by 6 weeks postpartum ("discontinuers") would have elevated postpartum inflammatory biomarker levels relative to women remaining on ART postpartum ("continuers").
  
  
  METHODS
  Data from HIV-infected pregnant women enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 with CD4 counts >350 cells per cubic millimeter before initiating ART or first pregnancy CD4 counts >400 cells per cubic millimeter after starting ART and with available stored plasma samples at >20 weeks of gestation, delivery, and 6 weeks postpartum were analyzed. Plasma samples were tested for highly sensitive C-reactive protein, D-dimer, and interleukin-6. We used longitudinal linear spline regression to model biomarkers over time.
  
  
  RESULTS
  Data from 128 women (65 continuers and 63 discontinuers) were analyzed. All biomarkers increased from late pregnancy to delivery, then decreased postpartum (slopes different from 0, P < 0.001). Continuers had a steeper decrease in log D-dimer between delivery and 6 weeks postpartum than discontinuers (P = 0.002).
  
  
  CONCLUSIONS
  In contrast to results from treatment interruption studies in adults, both ART continuers and ART discontinuers had significant decreases in the levels of D-dimer, highly sensitive C-reactive protein, or interleukin-6 postpartum. Continuation was associated with a more rapid decline in D-dimer levels compared with discontinuation.
authors.affiliation: *Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; †Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA; and ‡National Vaccine Program Office/Office of the Assistant Secretary for Health/Office of the Secretary/Department of Health and Human Services, Washington, DC.
authors.forename: Risa M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Erin
authors.initials: E
authors.lastname: Leister
authors.forename: Deborah
authors.initials: D
authors.lastname: Kacanek
authors.forename: David E
authors.initials: DE
authors.lastname: Shapiro
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bryson
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; C036309:fibrin fragment D; D002097:C-Reactive Protein