Chetty, T;
Newell, M-L;
Thorne, C;
Coutsoudis, A;
(2018)
Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal, South Africa, 2010-2015.
Tropical Medicine & International Health
, 23
(1)
pp. 79-91.
10.1111/tmi.13001.
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Abstract
Objectives: Pregnancy and post‐partum viral load suppression is critical to prevent mother‐to‐child HIV transmission and ensure maternal health. We measured viraemia risk before, during and after pregnancy in HIV‐infected women. // Methods: Between 2010 and 2015, 1425 HIV‐infected pregnant women on lifelong antiretroviral therapy (ART) for at least six months pre‐pregnancy were enrolled in a cohort study in rural KwaZulu‐Natal, South Africa. Odds ratios were estimated in multilevel logistic regression, with pregnancy period time‐varying. // Results: Over half of 1425 women received tenofovir‐based regimens (n = 791). Median pre‐pregnancy ART duration was 2.1 years. Of 988 women (69.3%) with pre‐pregnancy viral loads, 82.0%, 6.8% and 11.2% had VL <50, 50‐999 and ≥1000 copies/ml, respectively. During pregnancy and at six, 12 and 24 months, viral load was ≥1000 copies/ml in 15.2%, 15.7%, 17.8% and 16.6% respectively; viral load <50 was 76.9%, 77%, 75.5% and 75.8%, respectively. Adjusting for age, clinical and pregnancy factors, viraemia risk (viral load ≥50 copies/ml) was not significantly associated with pregnancy [adjusted OR (aOR) 1.31; 95% CI 0.90‐1.92], six months (aOR 1.30; 95% CI 0.83‐2.04), 12 months (aOR 0.96; 95% CI 0.58‐1.58) and 24 months (aOR 1.40; 95% CI 0.89‐2.22) post‐partum. Adjusting for ART duration–pregnancy period interaction, viraemia risk was 1.8 during pregnancy and twofold higher post‐partum. // Conclusions: While undetectable viral load before pregnancy through post‐partum was common, the UNAIDS goal to suppress viraemia in 90% of women was not met. Women on preconception ART remain vulnerable to viraemia; additional support is required to prevent mother‐to‐child HIV transmission and maintain maternal health.
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