Health outcomes of asymptomatic HIV-infected pregnant women initiating antiretroviral therapy at different baseline CD4 counts in Ethiopia

Abstract

Objective To compare health outcomes following initiation of antiretroviral therapy (ART) for asymptomatic HIV-infected pregnant women at different CD4 levels. Methods We analyzed data from 706 asymptomatic HIV-infected Ethiopian women initiating ART during pregnancy between February 2012 and October 2016. The outcomes evaluated were CD4 gain, CD4 normalization (CD4 count ≥750 cells/mm3) and occurrence of HIV-related clinical events after twelve months of treatment. Result On average, CD4 count (cells/mm3) increased from 391 (95% CI: 372–409) at baseline to 523 (95% CI: 495–551) after twelve months of treatment. Rate of CD4 gain was higher among women with baseline CD4 between 350 and 499 compared to CD4 ≥500 (207 versus 6, p < 0.001). But women with baseline CD4 between 350 and 499 could not catch up with women with CD4 ≥500. Women with baseline CD4 ≥500 had significantly higher likelihood of achieving CD4 normalization as compared to those with CD4 between 350 and 499 (AOR = 0.32, 95% CI: 0.13–0.76). No strong evidence of differential risk in the occurrence of HIV-related clinical events. Conclusion Starting ART for asymptomatic HIV-infected women with CD4 count ≥500 cells/mm3 was beneficial to preserve or recover immunity after 12 months of treatment in a resource limited setting.