However, this was a heterogeneous group with 13% of mothers having CD4 cell counts <200 cells/μL and the majority having counts between 201

and 500 cells/μL (66%) at commencement of cART. Nevertheless, the study did demonstrate that short-term exposure to cART during pregnancy did not jeopardize future response to treatment. It is uncertain whether untreated HIV infection or the discontinuation CHIR99021 of cART with virological suppression when the CD4 cell count is 350–500 cells/μL has detrimental effects but it is conceivable that treatment at this stage may prevent future morbidity. In view of this, where patient preference is to continue therapy and the physician believes there is no potential contraindication, in particular poor adherence postpartum, we believe the patient should be allowed to continue treatment. The randomized PROMISE study should provide a definitive

answer to this question. Recent data indicate a 96% reduction in transmission between heterosexual Alisertib chemical structure discordant couples if the infected partner is treated with HAART [112]. Therefore, a woman with a baseline CD4 cell count >350 cells/μL and an HIV VL >50 HIV RNA copies/mL can be offered continued therapy with HAART in this setting. 5.6.5. ART should be discontinued in all women who commenced HAART for PMTCT with a CD4 cell count >500 cells/μL unless there is discordance with her partner or co-morbidity as outlined in Section 6 (HIV and hepatitis virus coinfections). Grading: 2B Only one cohort study has demonstrated benefit in starting therapy in adults who have a CD4 cell count >500 cells/μL (NA-ACCORD) [106]: specifically, this was not observed in the ART-CC analysis [107]. In addition, several small CD4-guided interruption studies using a higher threshold than SMART of commencing below 350 cells/μL (TRIESTAN [113], STACCATO [114]) and seroconversion treatment studies

have not shown significant clinical benefit with fixed courses of early treatment [115]. Lastly, durable CD4 cell count benefits have been demonstrated in women receiving short-term ART oxyclozanide to prevent MTCT when initiating >500 cells/μL indicating no short-term harm in this strategy and possible benefits [116]. “
“Interleukin-2 (IL-2) therapy increased CD4 cell counts and delayed antiretroviral therapy (ART) initiation in HIV-infected patients in the Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) 119 trial. However, four cases of lymphoma were reported. Epstein−Barr virus (EBV) replication is associated with an increased risk of lymphoma in immunocompromised patients. We assessed whether IL-2 had an impact on EBV replication and the development of lymphoma. A total of 130 ART-naïve patients were randomized to receive IL-2 therapy (n = 66) or no treatment (n = 64).