HIV RNA viral load and CD4+ T-cell countes in HIV-infected pregnant women with and without treatment discontinuation in early pregnancy

BACKGROUND: In pregnant zomen taking antiretroviral treatment at Conception treatment may be transiently stopped for safety concerns. Limited data are available on the consequences of such discontinuations. METHODS: We used data from a national study to compare different treatment pathways during pregnancy. Overall, 321 women zere evaluated and classified into three groups: women not on treatment at Conception and who started treatment during pregnancy (starters; n=91); women on treatment at Conception who temporaly discontinued treatment during first trimester (discontinuers; n=114); and women on treatment at Conception who mainained treatment (continuers; n=116). RESULTS: At Conception, the three groups had similar CD4+ T-cell counts (499, 495 and 470 cessl/mm3, respectively; P>0.10); starters had disgnificantly higher median HIV RNA levels at Conception (5,690 copies/ml) compared with both continuers (58 copies/ml, P<0.001) and discuntinuers (49 copies/ml, P>0.001). Continuers maintained undetectable HIV RNA at all pregnancy trimesters, while dicontinuers showed at first and secondi trimester transient negative effects on HIV (4,776 and 386 copies/ml, respectively) and CD4+ T-cell levels (376 and 392 cells/mm3, respectively) which were reversed at last trimester (52 copies/ms and 432 cells/mm3, respectively). No significant differences were observed among the groups in HIV RNA and CD4+ T-cell counts at third trimester, preterm delivery, low Birth weight or mode of delivery. The number of cases of HIV trasmission and birth defects were too limited to allow comparisons. CONCLUSIONS: Early discontinuation of antiretroviral treatment in pregnancy produces transient virological and immunological effects without precluding the achievement of a good viral suppression at the end of pregnancy; no clinical consequences were observed.