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- IOC - Artigos de Periódicos [12642]
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PREDICTORS OF VIREMIA IN POSTPARTUM WOMEN ON ANTIRETROVIRAL THERAPY
Autor(es)
Hoffman, Risa M.
Warshaw, Meredith G.
Amico, K. Rivet
Pilotto, José
Masheto, Gaerolwe
Achalapong, Jullapong
Machado, Elizabeth
Chokephaibulkit, Kulkanya
Duarte, Geraldo
João, Esau
Graham, Kathleen K.
Knapp, Katherine M.
Stek, Alice M.
Scott, Gwendolyn B.
Coletti, Anne
Loftis, Amy J.
Chakhtoura, Nahida
Currier, Judith S.
PROMISE 1077HS Team
Warshaw, Meredith G.
Amico, K. Rivet
Pilotto, José
Masheto, Gaerolwe
Achalapong, Jullapong
Machado, Elizabeth
Chokephaibulkit, Kulkanya
Duarte, Geraldo
João, Esau
Graham, Kathleen K.
Knapp, Katherine M.
Stek, Alice M.
Scott, Gwendolyn B.
Coletti, Anne
Loftis, Amy J.
Chakhtoura, Nahida
Currier, Judith S.
PROMISE 1077HS Team
Afiliação
Division of Infectious Diseases. David Geffen School of Medicine. University of California. Los Angeles, Los Angeles, CA, USA.
Center for Biostatistics in AIDS Research. Harvard T.H. Chan School of Public Health. Boston, MA, USA.
Health Behavior & Health Education. School of Public Health. University of Michigan. Ann Arbor, MI, USA.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.
Botswana Harvard AIDS Institute Partnership. Gaborone, Botswana.
Chiang Rai Prachanukroh Hospital. Chiang Rai, Thailand.
Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão. Rio de Janeiro, RJ, Brasil.
Faculty of Medicine Siriraj Hospital. Mahidol University. Bangkok, Thailand.
Universidade de São Paulo. Escola de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil.
Hospital Federal dos Servidores do Estado. Departamento de Doenças Infecciosas. Rio de Janeiro, RJ, Brasil.
Children’s Diagnostic and Treatment Center. Fort Lauderdale, FL, USA.
Infectious Diseases Department. St Jude Children’s Research Hospital. Memphis, TN, USA.
Department of Obstetrics and Gynecology. School of Medicine. University of Southern California. Los Angeles, CA, USA.
School of Medicine. University of Miami Miller. Miami, FL, USA.
FHI 360. Durham, NC, USA.
Institute for Global Health and Infectious Diseases. University of North Carolina. Chapel Hill, NC, USA.
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) NIH. Bethesda, MD, USA.
Division of Infectious Diseases. David Geffen School of Medicine. University of California Los Angeles, Los Angeles, CA, USA.
PROMISE 1077HS Team
Center for Biostatistics in AIDS Research. Harvard T.H. Chan School of Public Health. Boston, MA, USA.
Health Behavior & Health Education. School of Public Health. University of Michigan. Ann Arbor, MI, USA.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.
Botswana Harvard AIDS Institute Partnership. Gaborone, Botswana.
Chiang Rai Prachanukroh Hospital. Chiang Rai, Thailand.
Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão. Rio de Janeiro, RJ, Brasil.
Faculty of Medicine Siriraj Hospital. Mahidol University. Bangkok, Thailand.
Universidade de São Paulo. Escola de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil.
Hospital Federal dos Servidores do Estado. Departamento de Doenças Infecciosas. Rio de Janeiro, RJ, Brasil.
Children’s Diagnostic and Treatment Center. Fort Lauderdale, FL, USA.
Infectious Diseases Department. St Jude Children’s Research Hospital. Memphis, TN, USA.
Department of Obstetrics and Gynecology. School of Medicine. University of Southern California. Los Angeles, CA, USA.
School of Medicine. University of Miami Miller. Miami, FL, USA.
FHI 360. Durham, NC, USA.
Institute for Global Health and Infectious Diseases. University of North Carolina. Chapel Hill, NC, USA.
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) NIH. Bethesda, MD, USA.
Division of Infectious Diseases. David Geffen School of Medicine. University of California Los Angeles, Los Angeles, CA, USA.
PROMISE 1077HS Team
Resumo em Inglês
Background: HIV-infected, postpartum women on antiretroviral therapy (ART) have high rates of viremia. We examined predictors of postpartum viremia in the PROMISE study. Methods: Women with pre-ART CD4+ T-cell counts $400 cells/mm3 who started ART during pregnancy were randomized postpartum to continue ART (CTART) or discontinue ART (DCART). Viral load and self-reported adherence were collected every 12 weeks, up to 144 weeks. Women in DCART reinitiated therapy when clinically indicated. Viremia was defined as 2 consecutive viral loads .1000 copies/mL after 24 weeks on ART. Adherence was dichotomized as missing versus not missing ART doses in the past 4 weeks. Predictors of viremia were examined using Cox proportional hazards regression with adherence as a time-varying covariate. Results: Among 802 women in the CTART arm, median age at entry was 27 years and median CD4+ T-cell count 696 cells/mm3. Of 175 women in CTART with viremia (22%), 141 had resistance data, and 12% had resistance to their current regimen. There was an estimated 0.12 probability of viremia by week 48 and 0.25 by week 144. Predictors of viremia included missed ART doses within the past 4 weeks, younger age, shorter duration of pre-entry ART, and being from the South American/Caribbean region. Of 137 women in DCART who reinitiated therapy, probability of viremia was similar to CTART (0.24 by week 96; 0.27 by week 144). Conclusions: Rates of postpartum viremia are high and viremia is more likely in younger postpartum women who start ART later in pregnancy. Interventions should target these higher-risk women.
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