Background:  HIV-RNA had been described to increase in the postpartum period compared with prepartum and peripartum in individuals on AZT monotherapy, dual nucleoside therapy, or no ART. Pregnancy itself has been implicated in the change in viral load set point which could affect women who discontinue ART at delivery.

Methods:  A retrospective chart review was performed on HIV-infected females under care at a university clinic from September 1999 to September 2003 to characterize HIV-RNA levels, CD4 cell counts before, during, and after pregnancy until 96 weeks postpartum. For statistical comparisons, we used the Wilcoxon signed ranks test and applied the Bonferroni correction for multiple comparisons.

Results:  In 114 women, 155 pregnancies were identified. Median age at time of delivery was 24 years; 77% of the women were black. Median nadir CD4⁺ cell count was 418 cells/mm³. In 115 of the completed pregnancies, all but 1 received ART for a median of 16 weeks during pregnancy; 90% were taking NNRTI- or PI-based regimens; 51% achieved an undetectable viral load at delivery. Vertical transmission occurred in 4/116 children. In 55/115 cases, women chose to continue ART after delivery. In the remaining 60 pregnancies in which ART was discontinued at the time of delivery, there were no significant differences in median HIV-RNA and CD4⁺ cell counts before pregnancy, during pregnancy, and postpartum weeks 12 to 24 and 25 to 36 as shown in the table below.

Conclusions:  In individuals who discontinued ART at delivery, the viral load returned to the prepregnancy set point. Our results suggest that antiretroviral therapy can be safely discontinued after delivery in individuals who did not have indication for treatment of HIV disease before pregnancy.

Keywords: postpartum; viral load setpoint; treatment interruption