HIV prognosis good for many pregnant women

NEW YORK (Reuters Health) - Provided they have access to highly active antiretroviral therapy (HAART), a potent combination of anti-HIV drugs, pregnant women infected with HIV generally fare well for several years after giving birth, according to a report in the Journal of Acquired Immune Deficiency Syndromes.

"The outcome of our patient (group), which reflects evolving practice in the general clinical setting, provides (doctors) with evidence of healthy maternal survival after pregnancy for up to 6 years," the investigators write.

Many earlier studies have focused on pregnancy outcomes in HIV-infected women, the authors explain, but few have examined longer-term outcomes after delivery.

Dr. Fabiola Martin from St. Mary's NHS Trust, London, and colleagues present results from an ongoing study of the clinical outcome and response to therapy postpartum in 311 HIV-infected pregnant women who gave birth to 343 infants.

Depending on their immune status, women received AZT (zidovudine) therapy during pregnancy, HAART during pregnancy only, or HAART during and after pregnancy. The average follow-up period was 33 months.

Overall, the team reports, the women experienced improvements in their immune system and a drop in HIV levels and 98 percent of all mothers survived through the last follow-up visit without progression to AIDS.

Three of 85 women who took zidovudine monotherapy during pregnancy, 2 of 154 who continued HAART postpartum, and 1 of 71 who received short-term HAART until delivery had disease progression.

One mother died from drug toxicity, and six developed an AIDS-defining infection, the report indicates, with no significant difference between the three treatment groups.

Most women in all three groups who were taking HAART at last follow-up had an adequate immune status and HIV was undetectable in the blood, the researchers note.

"These data can reinforce the growing confidence of women with HIV infection, who wish to start or extend their family," the researchers conclude. A frequency of mother-to-child transmission of HIV of less than 1 percent is achievable and, with access to HAART, progression to AIDS is uncommon, the authors conclude.

SOURCE: Journal of Acquired Immune Deficiency Syndromes, October 1, 2006.