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Factors associated with HIV RNA levels in pregnant women on non-suppressive highly active antiretroviral therapy at conception

Patel, D; Cortina-Borja, M; De Maria, A; Newell, ML; Thorne, C; European Collaborative Study, ; (2010) Factors associated with HIV RNA levels in pregnant women on non-suppressive highly active antiretroviral therapy at conception. Antiviral Therapy , 15 (1) 41 - 49. 10.3851/IMP1489. Green open access

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Abstract

Background: Little is known about pregnancy patterns and levels of HIV RNA in HIV-infected women conceiving on highly active antiretroviral therapy (HAART) with non-suppressed viral load (VL), nor about their therapeutic management.Methods: Linear mixed models were fitted to study changes in VL and potential associated factors including HAART type or duration and immune status among 127 women receiving HAART at conception with detectable VL enrolled in the prospective European Collaborative Study.Results: Median duration of HAART at conception was 10 months. A total of 78 (61%) women conceived while on protease inhibitor (PO-based HAART. Overall, 72 (57%) women remained on the same HAART regimen throughout pregnancy, 24 (19%) switched regimens and 31 (24%) interrupted HAART during early pregnancy. The intention-to-treat model indicated constant VL up to 10 gestational weeks; thereafter, levels decreased significantly, by 0.06 logic, copies/ml weekly until delivery. At baseline, immune status was significantly associated with HIV RNA levels. Excluding those with treatment interruption, there was no significant difference in VL slope between women who did and did not modify their HAART regimens (P=0.14); women conceiving on non-nucleoside reverse transcriptase inhibitor-based HAART had consistently lower VL throughout pregnancy than those on PI-based HAART (P=0.02). Most (64/103, 62%) women had detectable VL within 4 weeks of delivery (median 2.40 log(10) copies/ml). The overall mother-to-child transmission rate was 1.72% (95% confidence interval 0.21-6.1).Conclusions: Practices regarding management of women conceiving on HAART with detectable VL vary in Western Europe. The existence of this group of pregnant women highlights the need for improved monitoring of and support for treated women before they become pregnant, as well as during pregnancy.

Type: Article
Title: Factors associated with HIV RNA levels in pregnant women on non-suppressive highly active antiretroviral therapy at conception
Open access status: An open access version is available from UCL Discovery
DOI: 10.3851/IMP1489
Publisher version: http://dx.doi.org/10.3851/IMP1489
Language: English
Additional information: This is the author’s version of a work accepted for publication by International Medical Press. Changes resulting from the publishing process, including peer review, editing and formatting, might not be reflected in this document. A definitive version was published in Antiviral Therapy, 15 , 41-49, © 2010 International Medical Press.
Keywords: TO-CHILD TRANSMISSION, NONPREGNANT WOMEN, VIRAL LOAD, GREATER ADHERENCE, INHIBITOR THERAPY, INFECTED WOMEN, US WOMEN, MOTHER, PHARMACOKINETICS, TYPE-1
UCL classification: 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 Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Pop, Policy and Practice Prog
URI: https://discovery.ucl.ac.uk/id/eprint/1313085
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