Progression-Free Survival Common For Pregnant Women
October 30, 2006
(Reuters Health) - October 30, 2006 (Reuters Health)—For pregnant HIV-infected women with access to highly active antiretroviral therapy (HAART), the medium-term postpartum prognosis is good, according to a report in the October 1st Journal of Acquired Immune Deficiency Syndromes.
"The outcome of our patient cohort, which reflects evolving practice in the general clinical setting, provides clinicians with evidence of healthy maternal survival after pregnancy for up to 6 years," the investigators say.
Many earlier studies have focused on pregnancy outcomes in HIV-infected women, the authors explain, but few have examined longer-term outcomes after the management of HIV infection in pregnancy.
Dr. Fabiola Martin from St. Mary's NHS Trust, London, UK and colleagues present results from an ongoing prospective multicenter study of the clinical outcome and response to therapy postpartum in 311 HIV-infected pregnant women who had 343 babies.
Depending on their CD4 count, women received zidovudine monotherapy during pregnancy, short-term HAART during pregnancy only, or HAART during and after pregnancy.
Mean follow-up was 33 months. Overall, the team reports, women experienced a significant rise in median CD4 counts and reductions in median viral loads, and 98% of all mothers survived through the last follow-up visit without progression to AIDS.
Three of 85 women who took zidovudine monotherapy during pregnancy, 2 of 154 who continued HAART postpartum, and 1 of 71 who received short-term HAART until delivery progressed to CDC category C, the results indicate.
One mother died (from drug toxicity), and six developed an AIDS-defining infection (equivalent to 1 case per 141 person-years), the report indicates, with no significant difference among the three treatment groups.
Most women in all three groups who were taking HAART at last follow-up had CD4 counts above 200 cells/microliter and no detectable viremia, the researchers note.
"These data can reinforce the growing confidence of women with HIV infection, who wish to start or extend their family, that transmission rates less than 1% are achievable and that, with access to HAART, progression to AIDS is infrequent, regardless of the type of therapy taken during pregnancy," the authors conclude.
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