A prospective study of the effect of pregnancy on CD4 counts and plasma HIV-1 RNA concentrations of antiretroviral-naive HIV-1-infected women.
BACKGROUND
In HIV-1-infected women, CD4 count declines occur during pregnancy, which has been attributed to hemodilution. However, for women who have not initiated antiretroviral therapy, it is unclear if CD4 declines are sustained beyond pregnancy and accompanied by increased viral levels, which could indicate an effect of pregnancy on accelerating HIV-1 disease progression.


METHODS
In a prospective study among 2269 HIV-1-infected antiretroviral therapy-naive women from 7 African countries, we examined the effect of pregnancy on HIV-1 disease progression. We used linear mixed models to compare CD4 counts and plasma HIV-1 RNA concentrations between pregnant, postpartum, and nonpregnant periods.


RESULTS
Women contributed 3270 person-years of follow-up, during which time 476 women became pregnant. In adjusted analysis, CD4 counts were an average of 56 (95% confidence interval: 39 to 73) cells/mm lower during pregnant compared with nonpregnant periods and 70 (95% confidence interval: 53 to 88) cells/mm lower during pregnant compared with postpartum periods; these results were consistent when restricted to the subgroup of women who became pregnant. Plasma HIV-1 RNA concentrations were not different between pregnant and nonpregnant periods (P = 0.9) or pregnant and postpartum periods (P = 0.3). Neither CD4 counts nor plasma HIV-1 RNA levels were significantly different in postpartum compared with nonpregnant periods.


CONCLUSIONS
CD4 count declines among HIV-1-infected women during pregnancy are temporary and not sustained in postpartum periods. Pregnancy does not have a short-term impact on plasma HIV-1 RNA concentrations.
*Department of Global Health, University of Washington, Seattle, WA; †Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; ‡Department of Obstetrics & Gynaecology, University of Nairobi, Nairobi, Kenya; §Wits Reproductive Health and HIV Institute (WRHI), University of the Witwatersrand, Johannesburg, South Africa; ‖Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; ¶Kenya Medical Research Institute, Nairobi, Kenya; #Department of Reproductive Health, Moi University, Eldoret, Kenya; and **Departments of †Epidemiology and ††Medicine, University of Washington, Seattle, WA.
Renee
R
Heffron
Deborah
D
Donnell
James
J
Kiarie
Helen
H
Rees
Kenneth
K
Ngure
Nelly
N
Mugo
Edwin
E
Were
Connie
C
Celum
Jared M
JM
Baeten
D000328:Adult; D000349:Africa; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology* / Q000821:virology*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D019562:Viral Load
D012367:RNA, Viral