889 Clinical, Virologic, and Immunologic Changes after Delivery among Women Receiving Nucleoside Therapy during Pregnancy D. H. Watts*1, J. Lambert2, E. R. Stiehm3, D. R. Harris4, J. Bethel4, L. Mofenson1, B. Mathieson1, M. G. Fowler5, G. Nemo1, the PACTG 185 Study Team6 1Natl Inst of Hlth, NIH, Bethesda, MD; 2Glaxo-Wellcome, Middlesex, UK; 3Univ of California at Los Angeles; 4Westat, Rockville, MD; 5CDC, Atlanta, GA; and 6Pediatric AIDS Clin Trials Group, Silver Spring, MD
Background: Limited available data suggest that HIV RNA levels increase after delivery among women not receiving antiretroviral therapy (ART) during pregnancy or those on stable nucleoside therapy. In addition, the effects of ART, given only during pregnancy for prevention of HIV-1 transmission, on subsequent HIV disease progression have not been adequately evaluated.
Methods: PACTG 185, a trial of the efficacy of HIV immune globulin (HIVIG) versus IVIG in addition to ART in reducing perinatal transmission of HIV-1, enrolled women with CD4+ lymphocyte counts < 500/uL on ART, predominantly ZDV monotherapy. We evaluated changes in HIV RNA, CD4+ lymphocyte percentage, and clinical findings for up to 18 months (mos) after delivery among enrolled women. Repeated measures linear regression and proportional hazards modeling were used.
Results: Changes in HIV RNA between delivery and 12 wks postpartum were 0.47 log (p = 0.0004) for women stopping ART at delivery, 0.53 log (p < 0.0001) for women continuing dual nucleoside ART, and 0.27 log (p < 0.0001) for women continuing ZDV or other single ART. Changes in HIV RNA and CD4% through 18 mos postpartum were similar between women continuing or stopping monotherapy at delivery. Postpartum progression did not differ between women receiving HIVIG versus IVIG during pregnancy. The risk of progression to AIDS was reduced by combination ART postpartum.
Conclusions: Consistent with previous reports, HIV RNA levels increase in the postpartum period even among women on stable ART, although pathogenesis is unclear. HIVIG during pregnancy did not affect postpartum HIV course. Clinical progression postpartum was reduced by combination ART, suggesting that monotherapy during pregnancy did not nullify response to combination ART later.
