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Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries
Kristin M Wall1, Wasima Rida, Lisa B Haddad
1From the aDepartment of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; bRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; cBiostatistics Consultant, Arlington, VA; dDepartment of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; eMedical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; fRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; gRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; hRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; iDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; jThe Aurum Institute, Johannesburg and Rustenburg, South Africa; kKenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; lCentre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; mUniversity of Oxford, Oxford, United Kingdom; nDesmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; oSchool of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; pInternational AIDS Vaccine Initiative, New York, NY; and qDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA.
Background:
Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women.
Methods:
From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy.
Results:
Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different.
Conclusions:
In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted.
