Mortality among HIV-positive postpartum women with high CD4 cell counts in Zimbabwe

BACKGROUND: Whereas HAART initiated at CD4 cell counts 351-450 cells/ml reduces mortality compared with starting at lower CD4 levels there is currently no evidence for the advantages of initiating treatment at CD4 cell counts greater than 450 cells/ml. METHODS: Mortality hazard as a function of CD4 cell count was estimated among postpartum HIV-positive women in Zimbabwe using HIV-negative women as the reference group. RESULTS: Mortality within 24 months postpartum was 54 times higher among women with CD4 cell counts less than 200 cells/ml fell to 5.4 times higher for those with CD4 cell counts 400-600 cells/ml but fell little thereafter. For CD4 cell counts greater than 600 cells/ml the hazard was 6.2 (95% confidence interval 3.2-11.9). CONCLUSION: Early HAART initiation for all HIV-positive pregnant women may benefit individual mothers and infants and simultaneously reduce population HIV incidence.