Antiretroviral therapy was administered to 121 of 235 women (51.5%) prior to pregnancy; there was an increase from four of 37 (10.8%) in 1994–1999 to 117 of 204 (57.4%) in 2000–2008. ART was initiated within the first 14 weeks of pregnancy in 42 of 235 women (17.9%), ranging from three of 49 (6.1%) in 1994–1999 to 39 of 206 (18.9%) in 2000–2008. Seven per cent started treatment during the third trimester and 19 women (7.9%) never received ART, mainly because of unknown HIV
status during pregnancy and labour (Table 1). From year 2000, only seven women (3.4%) Navitoclax research buy did not receive ART in pregnancy; three women because of late diagnosis and two women because they refused to take any medication. In two cases the reason for no treatment was not given. Information about timing of ART initiation was not available for 20 women (7.8%). Changes in the use of ART over time are shown in Figure 1. ZDV monotherapy was used
most frequently for the prevention of MTCT in the mid 1990s. From 1997 dual drug therapy was used in some women, in 1998 HAART was introduced and from 2000 nearly all women received HAART, often in a regime including a protease inhibitor Talazoparib (PI). Because of concerns about teratogenic side effects of efavirenz, most of the 14 women in our study receiving this drug had it replaced with a PI early in pregnancy. The most commonly used HAART regimens were ZDV+lamivudine (3TC)+lopinavir+ritonavir (62 of 205; 30.2%) and ZDV+3TC+nelfinavir (47 of 205; 22.9%). Nearly 80% of the women continued their ART after delivery. Pneumocystis RAS p21 protein activator 1 jiroveci prophylaxis was administered to 17 of 203 pregnant women (8.4%). In 209 of 231 deliveries (90.5%), intrapartum ZDV was given (Table 2). The women who did not receive ZDV during labour were diagnosed after delivery, had a very fast delivery, delivered spontaneously at home, or refused treatment. The last mean CD4 cell count before
delivery was reported for 214 births (83.9%) and ranged from 55 to 1268 cells/μL (mean 472 cells/μL; median 444 cells/μL). The last mean CD4 cell count increased from 420 cells/μL in 1994–1999 to 476 cells/μL in 2000–2008 (P=0.06). Of 214 women, 19 (8.9%) had a CD4 cell count of <200 cells/μL (Table 1). Mean CD4 cell count at delivery according to time of ART treatment is shown in Figure 2. It appears that CD4 cell count was significantly higher at delivery when ART was initiated before week 14 of gestation than when it was initiated after week 14 (mean 484 cells/μL vs. 420 cells/μL; P<0.05), which was not explained by the women initiating ART in the third trimester. However, when women on ART at the time of conception were excluded from the analysis, this finding did not remain significant. No linear trend was found. Viral load at delivery was reported for 206 births and in 81% of these the women had undetectable levels of viral HIV RNA.