The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy
The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy
Objective: The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART).
Methods: Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50 copies/ml or less at delivery in 2006-2011, who started life-long cART during pregnancy (n = 321) or conceived on cART (n = 618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200 copies/ml) was assessed by Kaplan-Meier analysis; adjusted hazard ratios (aHRs) for the 0-3 and 3-12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.
Results: In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0-7.7] experienced viral rebound by 3 months, and 2.2% (1.4-3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58-4.39)] but not during the 3-12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22-32%) experienced viral rebound by 3 months, and 3.0% (1.6-4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58-12.29); 3-12 months: aHR 4.05 (2.03-8.09)].
Conclusion: In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.
adherence, HAART, hiv, postpartum women, pregnant women, viral load
2269-2278
Huntington, S.
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Thorne, C.
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Newell, M.-L.
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Anderson, J.
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Taylor, G.P.
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Pillay, D.
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Hill, T.
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Tookey, P.A.
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Sabin, C.
fbab6118-f4e6-4aaa-83e5-843dc5556a02
November 2015
Huntington, S.
0f66f263-9275-46e4-b513-a59c9bc4604a
Thorne, C.
7c72bba1-51dd-4587-a00f-881398dc6867
Newell, M.-L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Anderson, J.
a8c59b71-26f6-4ffc-86ea-590411509a9f
Taylor, G.P.
761e1609-0aca-4f85-9b2a-98b73db58d57
Pillay, D.
f5be10ef-edf2-46b9-9c80-61d6a6ed7ce4
Hill, T.
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Tookey, P.A.
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Sabin, C.
fbab6118-f4e6-4aaa-83e5-843dc5556a02
Huntington, S., Thorne, C., Newell, M.-L., Anderson, J., Taylor, G.P., Pillay, D., Hill, T., Tookey, P.A. and Sabin, C.
(2015)
The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy.
AIDS, 29 (17), .
(doi:10.1097/QAD.0000000000000826).
(PMID:26544700)
Abstract
Objective: The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART).
Methods: Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50 copies/ml or less at delivery in 2006-2011, who started life-long cART during pregnancy (n = 321) or conceived on cART (n = 618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200 copies/ml) was assessed by Kaplan-Meier analysis; adjusted hazard ratios (aHRs) for the 0-3 and 3-12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.
Results: In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0-7.7] experienced viral rebound by 3 months, and 2.2% (1.4-3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58-4.39)] but not during the 3-12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22-32%) experienced viral rebound by 3 months, and 3.0% (1.6-4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58-12.29); 3-12 months: aHR 4.05 (2.03-8.09)].
Conclusion: In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.
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Accepted/In Press date: 16 July 2015
Published date: November 2015
Keywords:
adherence, HAART, hiv, postpartum women, pregnant women, viral load
Organisations:
Faculty of Medicine
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Local EPrints ID: 386058
URI: http://eprints.soton.ac.uk/id/eprint/386058
PURE UUID: 56cdb829-ae03-44ac-9bb9-d3c7d19c9141
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Date deposited: 27 Jan 2016 16:44
Last modified: 15 Mar 2024 03:47
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Author:
S. Huntington
Author:
C. Thorne
Author:
J. Anderson
Author:
G.P. Taylor
Author:
D. Pillay
Author:
T. Hill
Author:
P.A. Tookey
Author:
C. Sabin
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