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Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal, South Africa, 2010-2015

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. Green open access

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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.

Type: Article
Title: Viraemia before, during and after pregnancy in HIV-infected women on antiretroviral therapy in rural KwaZulu-Natal, South Africa, 2010-2015
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/tmi.13001
Publisher version: https://doi.org/10.1111/tmi.13001
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: pregnancy, postpartum, viraemia, adolescents, HIV infection
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10059976
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