Initiation of antiretroviral therapy among pregnant women in resource-limited countries: CD4+ cell count response and program retention

Objective(s): Few data are available from resource-limited countries on long-term outcomes of HIV-infected women who initiate antiretroviral therapy (ART) during pregnancy. Design: Analysis of data from adult patients enrolled in the MTCT-Plus Initiative who initiated ART between 2003 and 2006 in seven countries in Sub-Saharan Africa and Thailand. Methods: Mean population changes were assessed and multivariable mixed linear regression modeling was used to examine covariate effects on differences in absolute CD4(+) cell count responses. Kaplan-Meier methods were used to examine program retention combining survival and losses to follow-up. Results: Of 2229 individuals initiating ART, 1688 were women, of which 605 were pregnant (median gestational age 7 months), 1083 were not pregnant, and 541 were men. The average CD4(+) response by 30 months on ART was 451 cells/mu l among women who were pregnant at ART initiation as compared with 435 cells/mu l among nonpregnant women (P = 0.53) and 349 cells/mu l among men (P < 0.001). In multivariable analysis, lower CD4(+) cell increase was independently associated with male sex, older age, and lower CD4(+) cell count at initiation. After 30 months on ART retention was 0.85 with no retention differences between pregnant women, nonpregnant women, and men. Conclusion: HIV-infected women in resource-limited countries who start ART during pregnancy have similar or better long-term CD4(+) cell count responses as compared with other adults. These data support efforts to provide pregnant HIV-infected women with access to ART in resource-limited countries. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins