HIV RNA Suppression during and after Pregnancy among Women in the HIV Outpatient Study, 1996 to 2015

J Int Assoc Provid AIDS Care. Jan-Dec 2018;17:2325957417752259. doi: 10.1177/2325957417752259.

Abstract

Objective: To examine HIV viral suppression during/after pregnancy.

Design: Prospective observational cohort.

Methods: We identified pregnancies from 1996 to 2015. We examined HIV RNA viral load (VL), VL suppression (≤500 copies/mL), and antiretroviral therapy (ART) status at pregnancy start, end, and 6 months postpartum. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for VL nonsuppression.

Results: Among 253 pregnancies analyzed, 34.8% of women exhibited VL suppression at pregnancy start, 60.1% at pregnancy end, and 42.7% at 6 months postpartum. Median VL (log10 copies/mL) was 2.80 (interquartile range [IQR]: 1.40-3.85) at pregnancy start, 1.70 (IQR: 1.40-2.82) at pregnancy end, and 2.30 (IQR: 1.40-3.86) at postpartum. Risk of postpartum VL nonsuppression was also lower among women on ART and with VL suppression at pregnancy end (versus those not; adjusted RR = 0.30, 95% CI: 0.17-0.53).

Conclusions: Maintaining VL suppression among US women remains a challenge, particularly during postpartum. Achieving VL suppression earlier during pregnancy benefits women subsequently.

Keywords: HIV; postpartum; pregnancy; viral suppression.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active*
  • Female
  • HIV Infections / drug therapy*
  • HIV-1
  • Humans
  • Odds Ratio
  • Outpatients
  • Pregnancy
  • Pregnancy Complications, Infectious / virology*
  • Prospective Studies
  • RNA, Viral / blood*
  • Viral Load / drug effects*

Substances

  • RNA, Viral