Mortality among HIV-positive postpartum women with high CD4 cell counts in Zimbabwe

Background: Whereas HAART initiated at CD4 cell counts 351-450 cells/mu l reduces mortality, compared with starting at lower CD4 levels, there is currently no evidence for the advantages of initiating treatment at CD4 cell counts greater than 450 cells/mu l. Methods: Mortality hazard, as a function of CD4 cell count, was estimated among postpartum HIV-positive women in Zimbabwe, using HIV-negative women as the reference group. Results: Mortality within 24 months postpartum was 54 times higher among women with CD4 cell counts less than 200 cells/mu l, fell to 5.4 times higher for those with CD4 cell counts 400-600 cells/mu l but fell little thereafter. For CD4 cell counts greater than 600 cells/mu l the hazard was 6.2 (95% confidence interval 3.2-11.9). Conclusion: Early HAART initiation for all HIV-positive pregnant women may benefit individual mothers and infants, and Simultaneously reduce Population HIV incidence. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins