The association of pregnancy and HIV disease progression: A retrospective study
Description
The purpose of this study was to determine whether pregnancy is associated with an acceleration of HIV disease progression in women who have a pregnancy while HIV-infected. A retrospective review of all women fifteen to thirty-five years of age who attended an HIV outpatient program from January 1989 through August 1995 was undertaken. The 192 women who had a term pregnancy after testing positive for HIV were compared to 164 women who were not pregnant during the same period. In addition, disease progression in the 45 women who had a CD4 count available before their pregnancy and 45 non-pregnant women matched on CD4 count at entry was compared. The main outcome measures were death, the occurrence of a first AIDS defining condition, or a condition indicative of symptomatic HIV. Disease progression was assessed using the Kaplan-Meier method and multivariate proportional hazards models The median follow-up in the cohort and matched analysis was 32 and 46 months respectively. Women with a term pregnancy were significantly more likely to be African-American (88% vs 78%, p $<$.05), younger than 22 years of age (51% vs 11%, p$<$.001), and to have entered the clinic with a higher median CD4 count (519 vs 433 cells/$\mu$l, p $<$.001). After adjusting for entry CD4 count, age, and anti-retroviral use, pregnancy was not associated with progression to symptomatic HIV (RR = 0.9, 0.6-1.3), AIDS (RR = 1.1, 0.6-2.0), or death (RR = 0.6, 0.3-1.3). In the matched analysis adjusting for demographic differences, there was also no significant increase in risk of progression to symptomatic HIV (RR = 1.6, 0.7-4.0), AIDS (RR = 1.3, 0.4-4.1), or death (RR = 1.0, 0.3-3.6). A CD4 count below 200 cells/$\mu$l and an AIDS defining condition at entry were predictive of death; a low CD4 count was also associated with progression to symptomatic HIV and AIDS. A repeated measures analysis of CD4 count in the year following pregnancy found a trend towards an increase in CD4 count in the pregnant women as compared to the non-pregnant women Pregnancy does not appear to accelerate the progression of HIV disease in women attending a publicly funded clinic