Pregnancy, antiretroviral therapy and HIV disease progression in women. (360G-Wellcome-081082_Z_06_Z)

Better understanding of the complex relationships between pregnancy, HIV disease progression and antiretroviral therapy (ART) used to prevent mother-to-child transmission (PMTCT) and/or to delay disease progression is essential to understand the longer term risks of pregnancy for HIV infected women. It is unknown whether a potential synergy between HIV and pregnancy-related immune changes, coupled with an indirect effect of less aggressive therapeutic management in pregnancy, could negatively af fect HIV disease progression in the years following delivery. Women with and without pregnancies since their HIV diagnosis will be compared to quantify the impact of pregnancy on HIV disease progression, through data linkage between the UK National Study on HIV in Pregnancy and Childbirth and the UK Collaborative HIV Cohort Study. An individual patient data meta-analysis of data from this and other European cohorts will be performed. A new prospective cohort study of Ukrainian HIV-infected wom en, recruited postnatally but identified antenatally/intrapartum will be established to estimate the impact of exposure to abbreviated antenatal ART for PMTCT, treatment and co-infection on the course of HIV infection and prognostic markers of HIV disease progression in this resource-poor setting. Results will guide the treatment and management of HIV-infected women during and after pregnancy.