Post-Antiretroviral Outcomes In A Cohort Of Women Who Discontinued Maternal Triple-Antiretrovirals Initially Used To Prevent Mother-To-Child Transmission During Pregnacy

INTRODUCTION: In 2012, The World Health Organization amended its guidelines for women receiving triple-Antiretrovirals (ARV) for PMTCT (Option B) to include the option to continue ARV indefinitely (Option B+). Data comparing maternal and infant outcomes by maternal triple-ARV discontinuation at 6 months postpartum versus continuation are limited 

METHODS: The Kisumu Breastfeeding Study  was a prospective, non-randomized,  clinical trial where 522 HIV infected ARV-naïve pregnant women received Triple-ARVs from 34 weeks’ gestation until 6 months postpartum when they were instructed to discontinue breastfeeding. Women with CD4 count less than 250 ells/mm3 or WHO stage III/IV continued ARV indefinitely. We used regression models to estimate the change in CD4 after discontinuing ARV and the adjusted relative risk (aRR) for factors associated with declines in maternal CD4. We compared maternal and infant outcomes following weaning by maternal ARV status between 6–24 months postpartum. 

RESULTS: At 6 months postpartum, 82 women continued while 366 discontinued ARV. Women initiating ARV with low CD4 (350–500 cells/mm3) were more likely to decline to <350 cells/mm3 within 6 months of stopping, independent of CD4 and viral load at discontinuation (aRR 9.8; p value = 0.002). Only, infant death (29) or HIV infection (9) was independently associated with maternal ARV discontinuation compared with continuation (10.1 percent versus 2.4 percent; p value = 0.04).

CONCLUSIONS: Evaluating CD4 count at initiation of PMTCT regimen and 6 months postpartum can identify women at risk for a steep CD4 decline who would benefit from continuing ARV for their own health.