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Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries

BACKGROUND: Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. METHODS: From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, R...

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Autores principales: Wall, Kristin M., Rida, Wasima, Haddad, Lisa B., Kamali, Anatoli, Karita, Etienne, Lakhi, Shabir, Kilembe, William, Allen, Susan, Inambao, Mubiana, Yang, Annie H., Latka, Mary H., Anzala, Omu, Sanders, Eduard J., Bekker, Linda-Gail, Edward, Vinodh A., Price, Matt A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287431/
https://www.ncbi.nlm.nih.gov/pubmed/27893488
http://dx.doi.org/10.1097/EDE.0000000000000590
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author Wall, Kristin M.
Rida, Wasima
Haddad, Lisa B.
Kamali, Anatoli
Karita, Etienne
Lakhi, Shabir
Kilembe, William
Allen, Susan
Inambao, Mubiana
Yang, Annie H.
Latka, Mary H.
Anzala, Omu
Sanders, Eduard J.
Bekker, Linda-Gail
Edward, Vinodh A.
Price, Matt A.
author_facet Wall, Kristin M.
Rida, Wasima
Haddad, Lisa B.
Kamali, Anatoli
Karita, Etienne
Lakhi, Shabir
Kilembe, William
Allen, Susan
Inambao, Mubiana
Yang, Annie H.
Latka, Mary H.
Anzala, Omu
Sanders, Eduard J.
Bekker, Linda-Gail
Edward, Vinodh A.
Price, Matt A.
author_sort Wall, Kristin M.
collection PubMed
description BACKGROUND: Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-52874312017-02-15 Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries Wall, Kristin M. Rida, Wasima Haddad, Lisa B. Kamali, Anatoli Karita, Etienne Lakhi, Shabir Kilembe, William Allen, Susan Inambao, Mubiana Yang, Annie H. Latka, Mary H. Anzala, Omu Sanders, Eduard J. Bekker, Linda-Gail Edward, Vinodh A. Price, Matt A. Epidemiology Infectious Diseases BACKGROUND: Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Lippincott Williams & Wilkins 2017-03 2017-02-01 /pmc/articles/PMC5287431/ /pubmed/27893488 http://dx.doi.org/10.1097/EDE.0000000000000590 Text en Copyright © 2016 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Infectious Diseases
Wall, Kristin M.
Rida, Wasima
Haddad, Lisa B.
Kamali, Anatoli
Karita, Etienne
Lakhi, Shabir
Kilembe, William
Allen, Susan
Inambao, Mubiana
Yang, Annie H.
Latka, Mary H.
Anzala, Omu
Sanders, Eduard J.
Bekker, Linda-Gail
Edward, Vinodh A.
Price, Matt A.
Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
title Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
title_full Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
title_fullStr Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
title_full_unstemmed Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
title_short Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
title_sort pregnancy and hiv disease progression in an early infection cohort from five african countries
topic Infectious Diseases
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287431/
https://www.ncbi.nlm.nih.gov/pubmed/27893488
http://dx.doi.org/10.1097/EDE.0000000000000590
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