Pregnancy and treatment interruption enhances progression of HIV‐infection if initial CD4 + T‐lymphocyte count is less than 700 cells/mm 3

Purpose of the study To determine velocity of immunological and virological progression of HIV‐infection in respect to pregnancy and short‐termed HAART. Methods Comparative retrospective study. Retrospective period ‐ 4 years. All women had initial CD4 + cell count in the range from 500 to 700 cells/mm 3 and viral load less then 5 log 10 copies/ml. The study group ‐ women having had pregnancy and short termed HAART (16 cases). The control group ‐ women not having had pregnancy and episodes of HAART. 3 endpoints were determined: (i) average year CD4+ T‐lymphocyte loss (cells/mm 3 ); (ii) average year% CD4+ T‐lymphocyte loss; (iii) average year viral load elevation (log 10 copies/ml). Endpoints were calculated by the least square regression. Summary of results Women in the study group showed higher progression rates of HIV infection, as shown in table 1 and figure 1 The difference in average year CD4 + T‐lymphocyte loss was 2,9 fold, average year% CD4 + T‐lymphocyte loss was 2,8 fold, average year viral load elevation ‐ 4,5 fold. All differences were statistically significant. Figure 1.95% confidence intervals showing significant influence of pregnancy and HAART termination on HIV‐disease progression. There was no statistically significant difference between the groups in the age of women and initial viral load. If the initial CD4 + counts were more the 700 cells/mm 3 , pregnancy and HAART termination does not have significant effect on immunological progression, difference in viral load dynamics being still present (data not shown). The study does not allow to differentiate effects of pregnancy itself or of HAART termination. According to literature effect of pregnancy on HIV disease progression is not clear [1], that is why the most reliable hypothesis is the unfavourable influence of HAART termination on the course of HIV‐infection. This provides a reliable evidence not to stop HAART after delivery if initial CD4 + count is less then 700 cells/ml. 1 analysis of HIV‐disease progression indices in women having pregnancy and HAART termination and notAverage Year Index Study group (with pregnancy) Control group (without pregnancy) t Significance (two‐tailed)CD4+ T‐lymphocyte loss (cells/mm 3 ) 79,6281 27,6484 2,404 0,019 % CD4+ T‐lymphocyte loss 12,4350 4,5067 2,342 0,023 viral load elevation (log 10 copies/ml) ,3830 ,0854 2,710 0,009Conclusions 1: Higher level of immunological progression is proved by elevated average year CD4 + T‐lymphocyte loss: in absolute count (cells/mm 3 ) and in% to the previous level. 2: Higher level of virological progression is proved by elevated average year viral load. 3: Enhancing progression of HIV‐infection is due to changing level of HIV after HAART termination on the background of weakened and disbalanced cellular immunity.