Maternal Treatment Outcomes of Antiretroviral Therapy Initiation before and during Pregnancy and associated factors at Jimma University Specialized Hospital, Southwest Ethiopia

Abstract

Treatment outcome of Human immunodeficiency virus infected individual can be evaluated using virological, immunological or clinical criteria. The immunological and clinical outcomes to Highly Active Antiretroviral Therapy among Human immunodeficiency virus infected pregnant women vary according to timing of Highly Active Antiretroviral Therapy initiation. Objective: To assess maternal treatment outcomes of antiretroviral therapy initiated before and during pregnancy and associated factors at Jimma University specialized Hospital. Method: Hospital based retrospective cohort study was conducted from March 3 to 29, 2013 by reviewing patients’ follow up cards from January 2008 to December 2012.Data were collected using data collection format prepared after review of similar literatures. The data were processed using SPSS version 16. Association between dependent and independent variables was determined using Chi-square tests and odds ratio. Independent predictors of maternal treatment outcome were identified by using logistic regression analysis. A p-value of < 0.05 was considered statistically significant. Result: A total of 202 Human immunodeficiency virus positive pregnant women with regular follow up from January 2008 – 2012 were included in the study. Of 202 Human immunodeficiency virus positive pregnant women, 115 (56.9%) started Highly Active Antiretroviral Therapy before pregnancy and 87 (43.1%) started Highly Active Antiretroviral Therapy during pregnancy. Among the study participants, 169(83.6%) and 142(70.3%) had good immunological and clinical outcome respectively. In adjusted logistic regression, unknown Human immunodeficiency virus status prior to pregnancy was 0.15 times more likely to have poor immunological outcome compared to known Human immunodeficiency virus status prior to pregnancy (AOR = 0.158, 95% CI = (0.041 – 0.602), P = 0.007). Baseline CD4 count < 200 was 0.02 times more likely to have poor immunological outcome compared to CD4 count ≥ 200 (AOR = 0.023, 95% CI = (0.003 – 0.190), P = 0.000). Women who started HAART treatment before pregnancy had good clinical outcome (AOR = 0.349, 95% CI = (0.157 – 0.776), P= 0.010). In adjusted logistic regression, baseline WHO clinical stage III was 7.673 times more likely to have poor clinical outcome compared to baseline WHO clinical stage I (AOR = 7.673, 95 % CI = 1.640 – 35.892, P= 0.010). Highly Active Antiretroviral Therapy initiation initiated during pregnancy was 0.3 times more likely to have poor clinical outcome compared to Highly Active Antiretroviral Therapy initiation initiated before pregnancy (AOR = 0.349, 95% CI = 0.157 – 0.776, P= 0.010).Total duration of treatment, 13 - 18 months was 0.193 times more likely to have poor clinical outcome compared to total duration of treatment > 18 months (AOR = 0.193, 95% CI =0.056 – 0.669, P= 0.010) Conclusions and recommendations: The independent predictors of maternal immunological outcome were Human immunodeficiency virus status prior to pregnancy and baseline CD4 lymphocyte count. Women that started Highly Active Antiretroviral Therapy treatment before pregnancy had good clinical outcome. The independent predictors of maternal clinical outcome were baseline WHO clinical stage, time of Highly Active Antiretroviral Therapy initiation and total treatment duration. Women in the reproductive age group should be encouraged to know their Human immunodeficiency virus status before pregnancy