Mode of delivery and postpartum HIV-1 disease progression: the Women and Infants Transmission Study
Navas-Nacher, E.L.; Read, J.S.; Leighty, R.M.; Tuomala, R.E.; Zorrilla, C.D.; Landesman, S.; Rosenblatt, H.; Hershow, R.C.
Aids 20(3): 429-436
2006
ISSN/ISBN: 0269-9370 PMID: 16439877 DOI: 10.1097/01.aids.0000206506.47277.e7Document Number: 253841
Objective: To assess the relationship between mode of delivery and subsequent maternal HIV-1 disease progression.Design and methods: Changes in CD4+ lymphocyte percentage (CD4%) and plasma HIV-1 RNA concentration (HIV RNA), and time to progression to AIDS or death among HIV-1-infected women were compared according to mode of delivery [cesarean section before labor and ruptured membranes (SCS), cesarean section after labor and/or after ruptured membranes (NSCS), and vaginal delivery]. Generalized estimating equations were used to compare changes in adjusted mean CD4% and HIV RNA counts by mode of delivery. Cox proportional hazard models were used to assess differences in time to AIDS or death.Results: In adjusted analyses, there were no clinically important differences in HIV-1 disease progression according to mode of delivery (SCS, n = 183; NSCS, n = 22 1; vaginal, n = 1087), as assessed by changes in CD4% and HIV RNA during the 18 months following delivery, and by progression to AIDS or death during a mean postpartum follow-up of 2.66 years.Conclusions: The present results suggest that, among HIV-1-infected women in North America, mode of delivery is not associated with subsequent HIV-1 disease progression. (C) 2006 Lippincott Williams & Wilkins.