Antiretroviral Therapy Is Effective In HIV Positive Women During Pregnancy
A recent study shows that pregnant women who are HIV positive may increase their immune response and decrease the amount of HIV in their bodies if given highly active antiretroviral therapy (HAART) during pregnancy.
HAART is typically composed of three to four different antiretroviral drugs and can help slow down replication of the virus and control HIV levels in the blood. For this reason antiretroviral therapy has proven successful in slowing the progression of HIV to AIDS and decreasing the likelihood of transmission of the virus to the fetus during pregnancy.
The study, published this September in the medical and science journal PLoS ONE, reviews the results of administering HAART to pregnant women before, during, and after pregnancy. The results found that women who began using the antiretroviral therapy before or during pregnancy had the greatest increase in CD4 cells and reduced HIV-1 RNA, while women who began using it after pregnancy showed the least benefit. However, there was no difference in the rates in which HIV progressed.
CD4 cells are white blood cells that help protect the body from foreign pathogens. When HIV infects humans, it mainly targets the CD4 cells and decreases their quantity, making it harder to fight infections.
This study looked at 112 HIV-positive women between 1997 and 2005; 12 started HAART before pregnancy, 70 started during pregnancy, and 30 after pregnancy. The average age of participants was 26 years. HIV -1 RNA and CD4 levels were monitored for 180 days after the start of antiretroviral therapy. In all 112 women studied, there were no cases of HIV-1 transmission to the fetus.
Pregnant women who do not use antiretroviral therapy during pregnancy have a 25 percent risk of infecting the fetus. With preventative treatment, the rate of transmission is between one and two percent.
Researchers concluded that several reasons may have caused HAART to be more effective when administered during pregnancy. Women who received HAART after pregnancy were more likely to have received previous treatment for HIV, which leads to poorer response to HAART. Second, improved diet and health behaviors during pregnancy, compared to those postpartum may have resulted in better immunologic responses. Women who receive antiretroviral therapy during pregnancy have been shown to be more likely to adhere to the regimen, since they see their doctors more frequently during that time. A third reason for this increased immunologic response could be in part due to increased estrogen and progesterone levels during pregnancy, which leads to an increase in CD4 cells.
Due to the small size of the study, differences in disease progression could not be determined. Larger studies with longer follow-up times may be necessary to assess the differences in disease progression in women who receive HAART before, during, or after pregnancy.
For more information, please see the full study in PLoS ONE.
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