Mortality among HIV-positive postpartum women

Mortality among HIV-positive postpartum women with high CD4 cell counts in Zimbabwe.

Hargrove J, Humphrey J, for the ZVITAMBO Study Group. AIDS. 2010. 24:F11–F14

Whereas antiretroviral treatment initiated at CD4 cell counts 351–450 cells/ml reduces mortality, compared with starting at lower CD4 levels, there is currently no evidence for the advantages of initiating treatment at CD4 cell counts greater than 450 cells/ml. Mortality hazard, as a function of CD4 cell count, was estimated among postpartum HIV-positive women in Zimbabwe, using HIV-negative women as the reference group. Mortality within 24 months postpartum was 54 times higher among women with CD4 cell counts less than 200 cells/ml, fell to 5.4 times higher for those with CD4 cell counts 400–600 cells/ml but fell little thereafter. For CD4 cell counts greater than 600 cells/ml the hazard was 6.2 (95% confidence interval 3.2–11.9).Early antiretroviral therapy initiation for all HIV-positive pregnant women may benefit individual mothers and infants, and simultaneously reduce population HIV incidence.

Editors’ note: The striking findings in this study that enrolled 14,110 postpartum women within 96 hours of delivery to a vitamin A supplementation trial call into question the new World Health Organisation (WHO) adult treatment guidelines. The guidelines recommend that antiretroviral therapy be provided for all HIV-infected pregnant women with CD4 cell counts <350>