Background: In the Mitra plus study of prevention of mother-to-child transmission of HIV-1, which included 501\nwomen in Dar es Salaam, Tanzania, triple antiretroviral therapy (ART) was given from late pregnancy throughout\nbreastfeeding up to 6 months postnatally. Here we report findings in a sub-cohort of women with ?200 CD4cells/?L at\nenrolment who were continued on ART for life and followed up during 24 months after delivery to determine virologic\nand immunologic responses, drug resistance and mortality.\nMethods: Blood samples for viral load and CD4 counts testing were collected at enrolment and at 3, 6, 12 and 24 months\npostpartum. HIV drug resistance testing was performed at 12 months. Data analysis included descriptive statistics and\nmultivariate analysis using Generalized Estimated Equations of 73 women with at least two postpartum assessments.\nThe mortality analysis included 84 women who had delivered.\nResults: The proportion of women with a viral load ?400 copies/mL was 97% (71/73) at enrolment, 16% (11/67), 22%\n(15/69), 61% (36/59) and 86% (48/56) at 3, 6, 12 and 24 months postpartum, respectively. The proportion of women with\nimmunologic failure was 12% (8/69), 25% (15/60) and 41% (24/58) at 6, 12 and 24 months, respectively. At 12 months,\ndrug resistance was demonstrated in 34% (20/59), including 12 with dual-class resistance. Self-report on drug adherence\nwas 95% (64/68), 85% (56/66), 74% (39/53) and 65% (30/46) at 3, 6, 12 and 24 months, respectively. The mortality rate\nwas 5.9% (95% CI 2.5-13.7%) at 24 months. The probability of virologic and immunologic failure was significantly higher\namong women who reported non-perfect adherence to ART at month 24 postpartum.\nConclusions: Following an initial decline of viral load, virologic failure was common at 12 and 24 months postpartum\namong women initiated on ART for life during pregnancy because of low CD4 cell counts. A high proportion of viremic\nmothers also had resistance mutations. However, at 24 months follow-up, the mortality rate was still fairly low. Continuous\nadherence counseling and affordable means of monitoring of the virologic response are crucial for successful implementation\nof the WHO Option B+ guidelines to start all HIV-infected pregnant women on ART for life.
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