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Public health policy and practice
Effectiveness of highly active antiretroviral therapy among HIV-1 infected women
  1. S J Gange1,
  2. Y Barrón1,
  3. R M Greenblatt2,
  4. K Anastos3,
  5. H Minkoff4,
  6. M Young5,
  7. A Kovacs6,
  8. M Cohen7,
  9. W A Meyer III8,
  10. A Muñoz1,
  11. For The Women's Interagency Hiv Study Collaborative Study Group
  1. 1Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, USA
  2. 2Departments of Medicine and Epidemiology, University of California at San Francisco, USA
  3. 3Montefiore Medical Center, New York, USA
  4. 4Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Health Sciences Center at Brooklyn, New York, USA
  5. 5Georgetown University Medical Center, Washington, USA
  6. 6Division of Pediatric Infectious Diseases and Comprehensive Maternal-Child HIV Management and Research Center, Los Angeles County, and the University of Southern California School of Medicine, Los Angeles, USA
  7. 7Cook County Hospital, Chicago, USA
  8. 8Quest Diagnostics Incorporated, Baltimore, USA
  1. Correspondence to:
 Dr S J Gange, Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, 615 N Wolfe Street, Room E-7010, Baltimore, MD 21205, USA;
 sgange{at}jhsph.edu

Abstract

Study objective: To describe the impact of highly active antiretroviral therapy (HAART) on mortality, morbidity, and markers of HIV disease progression in HIV infected women.

Design: Data collected from the Women's Interagency HIV Study, a prospective cohort study that enrolled women between October 1994 and November 1995.

Setting: Six clinical consortia based in five cities in the United States (New York, NY; Washington, DC; Los Angeles, CA; San Francisco, CA; and Chicago, IL).

Participants: A total of 1691 HIV seropositive women with a study visit after April 1996.

Main results: Beginning in April 1996, the self reported use of HAART increased over time, with more than 50% of the cohort reporting HAART use in 1999. There was a 23% decline per semester in the incidence of AIDS from April 1996 (95% confidence intervals (CI) −29% to −16%). Furthermore, there was a 21% decline of the semiannual mortality rates among those with AIDS at baseline (95% CI −27% to −14%) and an 11% decline among those AIDS free at baseline (95% CI −3% to −18%). CD4+ lymphocyte counts either increased (women with baseline AIDS) or stabilised (women without baseline AIDS) after April 1996, and HIV RNA levels dramatically declined in both groups, although the percentage of women with HIV RNA above 4000 cps/ml remained stable at approximately 40% since mid-1997.

Conclusions: Despite concerns regarding the use of antiretroviral therapies in this population, the use of therapies led to improved immunological function, suppressed HIV disease activity, and dramatic declines in morbidity and mortality.

  • HIV
  • AIDS
  • antiretroviral therapy
  • cohort study
  • HAART, highly active antiretroviral therapy
  • RTIs, reverse transcriptase inhibitors
  • ART, antiretroviral therapy
  • WIHS, Women's Interagency HIV Study

https://doi.org/10.1136/jech.56.2.153

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