Document Detail


Prevalent pregnancy, biological sex, and virologic response to antiretroviral therapy.
MedLine Citation:
PMID:  22487586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Pregnancy is a common indication for initiation of highly active antiretroviral therapy (HAART) in sub-Saharan Africa. Our objective was to evaluate how pregnancy at treatment initiation predicts virologic response to HAART.
METHODS: We evaluated an open cohort of 9173 patients who initiated HAART between April 2004 and September 2009 in the Themba Lethu Clinic in Johannesburg, South Africa. Risk ratios were estimated using log-binomial regression; hazard ratios were estimated using Cox proportional hazards models; time ratios were estimated using accelerated failure time models. We controlled for calendar date, age, ethnicity, employment status, history of smoking, tuberculosis, WHO stage, weight, body mass index, hemoglobin, CD4 count and CD4 percent, and whether clinical care was free. Extensive sensitivity and secondary analyses were performed.
RESULTS: During follow-up, 822 nonpregnant women and 70 pregnant women experienced virologic failure. In adjusted analyses, pregnancy at baseline was associated with reduced risk of virologic failure by 6 months [risk ratio 0.66, 95% confidence limits (CL): 0.35 to 1.22] and with reduced hazard of virologic failure over follow-up (hazard ratio: 0.69, 95% CL: 0.50 to 0.95). The adjusted time ratio for failure was 1.44 (95% CL: 1.13 to 1.84), indicating 44% longer time to event among women pregnant at baseline. Sensitivity analyses generally confirmed main findings.
CONCLUSIONS: Pregnancy at HAART initiation is not associated with increased risk of virologic failure at 6 months or during longer follow-up.
Authors:
Daniel Westreich; Denise Evans; Cindy Firnhaber; Pappie Majuba; Mhairi Maskew
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  60     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-24     Completed Date:  2012-10-02     Revised Date:  2013-08-19    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  489-94     Citation Subset:  IM; X    
Affiliation:
Department of Obstetrics and Gynecology and Duke Global Health Institute, Duke University, Durham, NC 27710, USA. daniel.westreich@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Africa
Anti-HIV Agents / administration & dosage*
Antiretroviral Therapy, Highly Active / methods*
Cohort Studies
Female
HIV Infections / drug therapy*,  virology
Humans
Male
Pregnancy
Pregnancy Complications, Infectious / drug therapy*,  virology
South Africa
Treatment Outcome
Viral Load*
Grant Support
ID/Acronym/Agency:
2P30-AI064518-06/AI/NIAID NIH HHS; 4R00-HD-06-3961-03/HD/NICHD NIH HHS; R00 HD063961/HD/NICHD NIH HHS; //PEPFAR
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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