Genetic associations of perinatal pain and depression

Underlying genetic influences may affect perinatal pain, depression, or both. We investigated the role of 59 single-nucleotide polymorphisms on 20 quantitative traits measured in perinatal women. Moreover, 183 pregnant women (28–37 weeks’ gestation) were prospectively genotyped for single-nucleotide polymorphisms with known prior associations with either pain or depression in nonpregnant populations. Prenatal saliva samples were collected. Phenotypic data were gathered during prenatal, labor and delivery, and postpartum (six weeks and three months) periods, capturing labor pain, Edinburgh Postnatal Depression Score, and Brief Pain Inventories. Following quality control, genotypes were used as predictors and phenotypes as dependent variables in multiple linear regression analyses to detect associations. Three statistical models were tested: additive allele effects, deviation from dominant allele effects, and the joint test of both. rs4633 (a synonymous single-nucleotide polymorphism in COMT) associated with “pain right now” scores at six weeks postpartum. Single-nucleotide polymorphisms rs1135349 (a single-nucleotide polymorphism within a small noncoding RNA that has many prior associations for depression) and rs7548151 (intronic in ASTN1) were associated with the maximum pain unpleasantness score experienced during labor (a measure of the emotional valence of labor pain), controlling for the Holm–Bonferroni family-wise error rate. Sensory dimensions of labor pain (i.e., pain intensity) and postpartum depression scores were not associated with genotyped single-nucleotide polymorphisms. Identifying genomic components of these perinatal complex disorders may produce insights into relevant pathways or novel treatment options.

Better Virological Outcomes Among People Living With Human Immunodeficiency Virus (HIV) Initiating Early Antiretroviral Treatment (CD4 Counts ≥500 Cells/µL) in the HIV Prevention Trials Network 071 (PopART) Trial in South Africa

BACKGROUND

There have been concerns about reduced adherence and human immunodeficiency virus (HIV) virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation.

METHODS

This prospective cohort study included adults initiating ART at facilities providing universal ART since January 2014. VS (<400 copies/mL), confirmed virological failure (VF) (2 consecutive viral loads >1000 copies/mL), and viral rebound were compared between participants in strata of baseline CD4 cell count.

RESULTS

The sample included 1901 participants. VS was ≥94% among participants with baseline CD4 count ≥500 cells/µL at all 6-month intervals to 30 months. The risk of an elevated viral load (≥400 copies/mL) was independently lower among participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200-499 cells/µL (9.2%) between months 18 and 30 (adjusted relative risk, 0.30 [95% confidence interval, .12-.74]; P = .010). The incidence rate of VF was 7.0, 2.0, and 0.5 per 100 person-years among participants with baseline CD4 count <200, 200-499, and ≥500 cells/µL, respectively (P < .0001). VF was independently lower among participants with baseline CD4 count ≥500 cells/µL (adjusted hazard ratio [aHR], 0.23; P = .045) and 3-fold higher among those with baseline CD4 count <200 cells/µL (aHR, 3.49; P < .0001).

CONCLUSIONS

Despite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200-499 cells/µL.

CLINICAL TRIALS REGISTRATION

NCT01900977.