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

Abstract

Objectives: Pregnancy and postpartum viral load (VL) suppression is critical to prevent mother-to-child HIV transmission (MTCT) 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 (OR) 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 VLs; 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, VL was ≥1000 copies/ml in 15.2%, 15.7%, 17.8%, and 16.6% respectively; VL<50 was 76.9%, 77%, 75.5% and 75.8%, respectively. Adjusting for age, clinical and pregnancy factors, viraemia risk (VL ≥50 copies/ml) was not significantly associated with pregnancy [adjusted OR (aOR) 1.31; 95% confidence interval (CI) 0.90-1.92], six month (aOR 1.30; 95% CI 0.83-2.04), 12 month (aOR 0.96; 95% CI 0.58-1.58) and 24 month (aOR 1.40; 95% CI 0.89-2.22) postpartum period. Adjusting for ART duration-pregnancy period interaction, viraemia risk was 1.8 and two-fold higher during pregnancy and postpartum, respectively. Conclusions: While undetectable VL before pregnancy through postpartum was high, the UNAIDS goal to suppress 90% of women was not met. Women on preconception ART remain vulnerable to viraemia; additional support is required to prevent MTCT and maintain maternal health.

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ORCID for Marie-Louise Newell: orcid.org/0000-0002-1074-7699

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