Pregnancy and Response to Antiretroviral Therapy in South Africa

这项提案的总体目标保持不变，是调查怀孕对 接受治疗的艾滋病毒感染妇女对高效抗逆转录病毒疗法的反应 南非约翰内斯堡。此外，我们还将继续开发先进的定量 本补助金K99部分培训部分中描述的流行病学方法。 南非孕妇艾滋病毒感染率大大高于 其他成年人。尽管对预防母婴传播的干预措施进行了广泛的研究， 艾滋病毒的感染，以及在这种干预措施期间和之后对抗逆转录病毒治疗的反应， 怀孕本身对治疗反应和保留的影响。充分认识影响 孕妇对HAART的反应对于为H1 V+提供良好的临床护理至关重要 在非洲和其他地方。为了解决这些问题，这项工作建议审查 妊娠对HAART免疫应答、HAART临床（AIDS/死亡）应答 坚持高效抗逆转录病毒疗法和保持护理。因为这是不可能的（也是非常不道德的）， 随机化妊娠暴露，本研究将依赖于在 南非约翰内斯堡的Themba Lethu诊所，一个城市抗逆转录病毒治疗诊所， 与威特沃特斯兰德大学的临床艾滋病研究单位合作。的主要研究者 丹尼尔韦斯特赖希博士在进行高质量研究方面有着良好的记录 与诊所的研究人员和临床医生合作。对这些数据的分析将需要 使用结构模型，一种先进的流行病学方法。

The overall goal of this proposal remains unchanged and is to investigate the effect of pregnancy on response to highly active antiretroviral therapy (HAART) among HIV-i- women in treatment in Johannesburg, South Africa. In addition, we will continue developing the advanced quantitative epidemiologic methods described in the training component ofthe K99 portion of this grant. Prevalence of HIV among pregnant women in South Africa is substantially higher than that among other adults. Despite extensive study of interventions for the prevention of mother to child transmission of HIV, and response to antiretroviral therapy during and after such interventions, little is known about the effect of pregnancy itself on responses to and retention in therapy. Fully understanding the effect of pregnancy on maternal responses to HAART is essential to providing good clinical care to H1V+ women in Africa and elsewhere. To address these questions, this work proposes to examine the effect of pregnancy on immunologic responses to HAART, clinical (AIDS/death) responses to HAART, and to adherence to HAART and retention in care. Because it is impossible (and highly unethical) to randomize the exposure of pregnancy, this study will rely on high quality clinical data collected in the Themba Lethu Clinic in Johannesburg, South Africa, an urban antiretroviral therapy clinic associated with the Clinical HIV Research Unit at the University ofthe Witwatersrand. The Principal Investigator of the proposed work, Dr. Daniel Westreich, has a strong track record in producing high quality research in collaboration with investigators and clinicians at the Clinic. The analysis of these data will require the use of structural models, an advanced body of epidemiologic methods.