Pregnancy may be followed by an inflexion of the immune reconstitution in HIV‐infected women who receive antiretroviral drugs before conception

Background Whether pregnancy has an impact on the evolution of CD4 cell counts in women treated with highly potent antiretrovirals before conception remains largely unknown. Methods Among patients enrolled in the ANRS CO8 (APROCO/COPILOTE) cohort, we selected all women aged between 18 and 50 years at initiation of combination antiretroviral therapy (cART). Slopes of CD4 cell counts during follow‐up were estimated using mixed longitudinal models with time‐dependent indicators for pregnancy and delivery. Results Of the 260 selected HIV‐infected women, a pregnancy occurred in 39 women in a median follow‐up time of 66 months. Women who became pregnant had higher CD4 cell count at baseline but this difference progressively lessened during follow‐up because they had a slower increase than women who did not become pregnant. The estimated slope of CD4 cell count decreased significantly from +2.3 cells/μL/month before pregnancy and in women who did not become pregnant to −0.04 cells/μL/month after delivery (P=0.0003). Conclusion A significant increase in CD4 cell count may be preferable before pregnancy in women treated with cART, in order to overcome the evolution observed after pregnancy.