Mothers with early stage HIV infection can reduce the risk of transmitting the virus to their babies by receiving antiretroviral treatment (ART) in the weeks before and after delivery. But there has been a lack of evidence as to whether the risks from continuous use of ART after delivery (postpartum) — such as toxicity or not following doctors’ instructions — are outweighed by any clinical benefit to these mothers.
In a new study, Judith Currier and colleagues set out to investigate this question. They recruited nearly 2,000 young, postpartum, HIV-positive women across eight countries for a randomized controlled clinical trial. The mothers were randomly assigned to either continue their ART regimen after delivery or stop using ART until prescribed by a study clinician. The participants were monitored over an average of 2.3 years, with study clinicians changing ART regimens for both groups based on patient needs.
Over the monitoring period, the group that continued using ART experienced half as many signs or symptoms of HIV progression as the group that stopped using ART postpartum, according to criteria set by the World Health Organization (WHO)’s four-stage HIV staging system. This suggests that it may be beneficial for mothers to continue an ART regimen after delivery into the postpartum period. However, many of these mothers struggled to keep to the regimen and developed elevated levels of HIV in the bloodstream, indicating that some challenges remain. Fortunately, both groups showed a very low rate of severe non-AIDS clinical events, such as progression to WHO stage 4 or death, over the follow-up period. “The data from this randomized trial provide further evidence of the benefits of continuing antiretroviral therapy after delivery in women with early stage HIV,” says Currier. “The study also highlights the challenges of adherence to ART over the long term, an issue we must find ways to address to maximize the benefits of treatment for women living with HIV.”
Research Article: Currier JS, Britto P, Hoffman RM, Brummel S, Masheto G, Joao E, et al. (2017) Randomized trial of stopping or continuing ART among postpartum women with pre-ART CD4 ≥ 400 cells/mm3 . PLoS ONE 12(5): e0176009. https://doi.org/10.1371/journal.pone.0176009
Image Credit: Pregnancy by Tatiana Vdb via Flickr