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Effect of Postpartum HIV Treatment Discontinuation on Long-Term Maternal Outcome

Washington University School of Medicine, St. Louis, Missouri, nonen{at}im.wustl.edu

Diana Nurutdinova, MD

St. Louis VA Medical Centre, St. Louis, Missouri

Somnuek Sungkanuparph, MD

Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Debra Gase, RN, MSN, BCFNP

Washington University School of Medicine, St. Louis, Missouri

Kristin Mondy, MD

Washington University School of Medicine, St. Louis, Missouri

E. Turner Overton, MD

Washington University School of Medicine, St. Louis, Missouri

Background. Long-term maternal outcomes after postpartum antiretroviral therapy (ART) discontinuation are unknown. Methods. Retrospective review of pregnancies in HIV-infected women on treatment between 1997 and 2005. Women were grouped by postpartum ART use and followed until new opportunistic infection (OI), death or last clinic visit. Results. Of 172 pregnancies, postpartum ART discontinuation occurred in 123 (71.5%) women and was associated with greater parity, no partner during pregnancy, and no indication for OI prophylaxis or preconception ART in multivariate analysis (P < .05). Median follow-up was 32.5 months after delivery. There were 12 OIs and 2 deaths; 10 OIs and both deaths occurred in women who had discontinued ART. Conclusion. Postpartum ART discontinuation is common, especially among those with less advanced HIV disease, but may leave women at increased risk of long term adverse outcomes. This study highlights the need for larger longitudinal studies to determine appropriate recommendations for postpartum ART administration.

Key Words: HIV • pregnancy • antiretroviral therapy discontinuation • maternal outcome

This version was published on September 1, 2008

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 7, No. 5, 245-251 (2008)
DOI: 10.1177/1545109708325466


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