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Observational Study
. 2018 Jan-Dec:17:2325957417752259.
doi: 10.1177/2325957417752259.

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

Monita Patel  1 , Ellen Tedaldi  2 , Carl Armon  3 , Steven Nesheim  1 , Margaret Lampe  1 , Frank Palella Jr  4 , Richard Novak  5 , Madeline Sutton  1 , Kate Buchacz  1 ; HOPS Investigators
Affiliations
Observational Study

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

Monita Patel et al. J Int Assoc Provid AIDS Care. 2018 Jan-Dec.

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.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Box plot of log10 HIV RNA viral load (VL) at time points during and after pregnancy, HIV Outpatient Study, 1996 to 2015 (N = 253). Not all women have HIV VL documented at all time points: 184 (72.7%) had a VL documented at pregnancy start, 211 (83.4%) at pregnancy end, and 188 (74.3%) at 6 months postpartum.
Figure 2.
Figure 2.
Viral suppression among women on antiretroviral therapy (ART) at time points during and after pregnancy, HIV Outpatient Study, 1996 to 2015.
Figure 3.
Figure 3.
Distribution of regimens during and after pregnancy among those on antiretroviral therapy (ART), HIV Outpatient Study, 1996 to 2015 (N = 253).
See this image and copyright information in PMC

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