Effect of pregnancy on immunological and virological outcomes of women on ART: a prospective cohort study in rural Uganda, 2004–2009

• Published in: Tropical medicine & international health 2012-03, Vol.17 (3), p.343-352
• Main Authors: Mayanja, Billy N., Shafer, Leigh Anne, Van der Paal, Lieve, Kyakuwa, Nassim, Ndembi, Nicaise, Hughes, Peter, Maher, Dermot, Grosskurth, Heiner
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; antiretroviral therapy; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; embarazo; Female; femmes; General aspects; grossesse; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; Human viral diseases; Humans; immunological outcomes; infección por VIH; infection par le VIH; Infectious diseases; Logistic Models; Medical sciences; mujeres; Pharmacology. Drug treatments; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - immunology; Pregnancy Complications, Infectious - virology; Pregnancy Rate; Prospective Studies; resultados inmunológicos; resultados virológicos; Rural Population; résultats immunologiques; résultats virologiques; Statistics, Nonparametric; terapia antirretroviral; thérapie antirétrovirale; Uganda; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; virological outcomes; women; Young Adult
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2011.02921.x

Objectives  Before antiretroviral therapy (ART) introduction, pregnancy was associated with a sustained drop in CD4 cell count in HIV‐infected women. We examined the effects of pregnancy on immunological and virological ART outcomes. Methods  Between January 2004 and March 2009, we studied HIV‐infected women receiving ART in a prospective open cohort study in rural Uganda. We used random effects regression models to compare the CD4 counts of women who became pregnant and those who did not, and among the pregnant women before and after pregnancy. CD4 count and proportions with detectable viral load (≥400 copies/ml) were compared between the two groups using the Mann–Whitney rank sum test and logistic regression respectively. Results  Of 88 women aged 20–40 years receiving ART, 23 became pregnant. At ART initiation, there were no significant differences between those who became pregnant and those who did not in clinical, immunological and virological parameters. Among women who became pregnant, CD4 cell count increased before pregnancy (average 75.9 cells/mm3 per year), declined during pregnancy (average 106.0) but rose again in the first year after delivery (average 88.6). Among women who did not become pregnant, the average CD4 cell count rise per year for the first 3 years was 88.5. There was no significant difference in the proportions of women with detectable viral load at last clinic visit among those who became pregnant (8.7%) and those who did not (16.1%), P = 0.499. Conclusion  Pregnancy had no lasting effect on the immunological and virological outcomes of HIV‐infected women on ART. Objectifs:  Avant l’introduction des antirétroviraux (ARV), la grossesse était associée à une baisse continue des taux de CD4 chez les femmes infectées par le VIH. Nous avons examiné les effets de la grossesse sur les résultats ARV immunologiques et virologiques. Méthodes:  Entre janvier 2004 et mars 2009, nous avons étudié des femmes infectées recevant l’ARV dans une étude de cohorte prospective ouverte en zone rurale en Ouganda. Nous avons utilisé des modèles de régression à effets aléatoires pour comparer les taux de CD4 des femmes qui sont et celles qui ne sont pas tombées enceintes, et pour celles qui sont tombées enceintes, les taux avant et après la grossesse. La numération des CD4 et les proportions avec une charge virale détectable (≥400 copies/ml) ont été comparées entre les deux groupes en utilisant le test de Mann–Whitney et la régression logistique, respect