title: Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries.
abstract: Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women.
  
  
  
  From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy.
  
  
  
  Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different.
  
  
  
  In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted.
authors.affiliation: From the aDepartment of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; bRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; cBiostatistics Consultant, Arlington, VA; dDepartment of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; eMedical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; fRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; gRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; hRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; iDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; jThe Aurum Institute, Johannesburg and Rustenburg, South Africa; kKenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; lCentre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; mUniversity of Oxford, Oxford, United Kingdom; nDesmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; oSchool of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; pInternational AIDS Vaccine Initiative, New York, NY; and qDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Wasima
authors.initials: W
authors.lastname: Rida
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Haddad
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kamali
authors.forename: Etienne
authors.initials: E
authors.lastname: Karita
authors.forename: Shabir
authors.initials: S
authors.lastname: Lakhi
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
authors.forename: Mubiana
authors.initials: M
authors.lastname: Inambao
authors.forename: Annie H
authors.initials: AH
authors.lastname: Yang
authors.forename: Mary H
authors.initials: MH
authors.lastname: Latka
authors.forename: Omu
authors.initials: O
authors.lastname: Anzala
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Vinodh A
authors.initials: VA
authors.lastname: Edward
authors.forename: Matt A
authors.initials: MA
authors.lastname: Price
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007630:Kenya; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000276:immunology*; D016016:Proportional Hazards Models; D012432:Rwanda; D013019:South Africa; D014454:Uganda; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents