HIV in pregnancy: do counts really count?

Background: HIV screening in antenatal women is being conducted routinely in most countries today. It is necessary to identify the infection to start antiretroviral drugs as soon as the diagnosis is confirmed. The antiretroviral treatment helps to reduce the risk of mother-to-child HIV transmission (MTCT) as well as prevent maternal morbidity. In present study we aim to identify the relevance of measuring CD4 counts in respect to perinatal transmission and risk of maternal tuberculosis in HIV infected antenatal women. Methods: In an observational study, 64 antenatalHIV positive women on antiretroviral therapy were studied for their demographic profile, the CD4 counts, mode of delivery and presence of concomitant pulmonary tuberculosis, over 3 years (2014-2016). HIV status of the newborns was then confirmed by dried blood spot test at the end of 18 months. Results • MTCT risk was not significantly higher in women with low CD4 counts as compared to women with high counts (p=0.69). • HIV positive women with lower CD4 counts were at risk of having concomitant pulmonary tuberculosis at rates similar to those with higher counts.(p=0.85) Conclusion: Routine measurement of CD4 counts during antenatal period in HIV positive women may be omitted owing to their doubtful role in determining perinatal transmission or maternal immune response to occurrence of tuberculosis. In countries with low resource settings and restricted infrastructure the omission may prove beneficial in reducing treatment cost especially when the counts do not dictate even the commencement of antiretroviral therapy in affected individuals.