Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

Reduction of Maternal Mortality with Highly Active Antiretroviral Therapy in a Large Cohort of HIV-Infected Pregnant Women in Malawi and Mozambique

“…It appears, however, that HIV also increases the risk of death due to obstetrical complications, including hemorrhage, miscarriage or sepsis [11], [13], [14]. Pregnancy is a vulnerable immunologic state where women are more prone to acquiring HIV infection [15].…”

5.0 Use of antiretroviral therapy in pregnancy

“…In a further retrospective study on mothers discontinuing therapy between 1997 and 2005 , more opportunistic infections and deaths were found in those who discontinued; however, this was a small, uncontrolled review where 46% had previous ART exposure and 36% a pre‐ART CD4 cell count of <350 cells/μL. Lastly, in a large cohort of women who were enrolled in South America and followed up for 6–12 weeks after discontinuation of ART given to prevent MTCT, significant falls in the CD4 cell percentage were seen as would be expected .…”

“…Available RCT data to address the question as to whether one should continue or stop HAART in women receiving it to prevent MTCT and not for their own health are sparse and have limited applicability to current ART treatment practices. What information there is comes from early RCTs with zidovudine monotherapy with or without HIV immunoglobulin and from observational studies with their inherent weaknesses [[[#]]148]. Nevertheless, concerns have been raised regarding the discontinuation of ARVs postpartum in light of results from CD4‐guided interruption studies (SMART and TRIVICAN in particular) although interruption of ART given for PMTCT after delivery is not completely analogous.…”

BritishHIVAssociation guidelines for the management ofHIVinfection in pregnant women 2012 (2014 interim review)

“…However, this was a small, uncontrolled review where 46% had had previous ARV exposure and 36% had a pre‐ARV CD4 cell count of < 350 cells/μL. Lastly, in a large cohort of women who were enrolled in South America and followed up for 6–12 weeks after discontinuation of ARVs given to prevent MTCT, significant falls in the CD4% were seen as would be expected .…”

“…Available RCT data to address the question as to whether one should continue or stop cART in women receiving it to prevent MTCT and not for their own health is sparse and has limited applicability to current ART treatment practices. What information there is comes from early RCTs with zidovudine monotherapy with or without HIV immunoglobulin and from observational studies with their inherent weaknesses . Nevertheless, concerns have been raised regarding the discontinuation of ARVs postpartum in light of the results from CD4‐guided interruption studies (SMART and TRIVICAN in particular) although the interruption of ARV given for PMTCT after delivery is not completely analogous.…”