Treatment Failure, Drug Resistance, and CD4 T-Cell Count Decline Among Postpartum Women on Antiretroviral Therapy in South Africa.
BACKGROUND
We assessed HIV RNA suppression, resistance, and CD4 T-cell count 12 months postpartum among pregnant women retained in care in an observational cohort study.


METHODS
We prospectively followed two groups of HIV-infected pregnant women--with or without tuberculosis--recruited from prenatal clinics in South Africa. Women who received antiretroviral therapy during pregnancy and reported being on therapy 12 months postpartum were included. Serum samples from women with HIV viremia 12 months postpartum were tested for drug resistance.


RESULTS
Of 103 women in the study, median age and CD4 T-cell count at enrollment were 29 years [interquartile range (IQR): 26-32] and 317 cells per cubic millimeter (IQR: 218-385), respectively; 43 (42%) had tuberculosis at baseline. During pregnancy, 87% of the women achieved an HIV RNA <400 copies per milliliter compared with 71% at 12 months postpartum (P < 0.001). Factors independently associated with an HIV RNA <400 copies per milliliter at 12 months were age ≥ 30 years, detectable plasma efavirenz concentration, and HIV RNA <400 copies per milliliter while pregnant; there was a trend toward both a detectable viral load and peripartum depression. HIV drug resistance results were available from 25 women, and 12 (48%) had major drug resistance mutations. CD4 T-cell count declined a median of 13 cells per cubic millimeter (IQR: -66 to 140) from delivery to 12 months in women with viremia at 12 months.


CONCLUSIONS
Success with maintaining virologic control declined postpartum among HIV-infected women who remained in care and on antiretroviral therapy, and CD4 T-cell count decline and drug resistance were common.
*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD;†Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa;‡Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; and§Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
Christopher J
CJ
Hoffmann
Silvia
S
Cohn
Fildah
F
Mashabela
Jennifer D
JD
Hoffmann
Helen
H
McIlleron
Paolo
P
Denti
David W
DW
Haas
Kelly E
KE
Dooley
Neil A
NA
Martinson
Richard E
RE
Chaisson
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology*; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D013019:South Africa; D017211:Treatment Failure; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents; D012367:RNA, Viral