HIV viraemia and mother‐to‐child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa

Objectives Maternal HIV viral load (VL) drives mother‐to‐child HIV transmission (MTCT) risk but there are few data from sub‐Saharan Africa, where most MTCT occurs. We investigated VL changes during pregnancy and MTCT following antiretroviral therapy (ART) initiation in Cape Town, South Africa. Metho...

Full description

Saved in:

Bibliographic Details
Published in:	HIV medicine Vol. 18; no. 2; pp. 80 - 88
Main Authors:	Myer, L, Phillips, TK, McIntyre, JA, Hsiao, N‐Y, Petro, G, Zerbe, A, Ramjith, J, Bekker, L‐G, Abrams, EJ
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-02-2017
Subjects:	Adolescent Adult Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Disease transmission Drug therapy Female Gestation Health risks HIV HIV Infections - drug therapy HIV Infections - virology Human immunodeficiency virus Humans Infant, Newborn Infectious Disease Transmission, Vertical - prevention & control Lentivirus Longitudinal Studies mother‐to‐child transmission Polymerase chain reaction Postpartum Pregnancy Pregnancy Complications, Infectious - drug therapy Pregnancy Complications, Infectious - virology Prospective Studies Retroviridae Ribonucleic acid Risk Risk Assessment RNA South Africa Therapy Viral Load Viremia Young Adult South Africa Cape Town South Africa viral load HIV antiretroviral therapy pregnancy mother-to-child transmission
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objectives Maternal HIV viral load (VL) drives mother‐to‐child HIV transmission (MTCT) risk but there are few data from sub‐Saharan Africa, where most MTCT occurs. We investigated VL changes during pregnancy and MTCT following antiretroviral therapy (ART) initiation in Cape Town, South Africa. Methods We conducted a prospective study of HIV‐infected women initiating ART within routine antenatal services in a primary care setting. VL measurements were taken before ART initiation and up to three more times within 7 days postpartum. Analyses examined VL changes over time, viral suppression (VS) at delivery, and early MTCT based on polymerase chain reaction (PCR) testing up to 8 weeks of age. Results A total of 620 ART‐eligible HIV‐infected pregnant women initiated ART, with 2425 VL measurements by delivery (median gestation at initiation, 20 weeks; median pre‐ART VL, 4.0 log10 HIV‐1 RNA copies/mL; median time on ART before delivery, 118 days). At delivery, 91% and 73% of women had VL ≤ 1000 and ≤ 50 copies/mL, respectively. VS was strongly predicted by time on therapy and pre‐ART VL. The risk of early MTCT was strongly associated with delivery VL, with risks of 0.25, 2.0 and 8.5% among women with VL < 50, 50–1000 and > 1000 copies/mL at delivery, respectively (P < 0.001). Conclusions High rates of VS at delivery and low rates of MTCT can be achieved in a routine care setting in sub‐Saharan Africa, indicating the effectiveness of currently recommended ART regimens. Women initiating ART late in pregnancy and with high VL appear substantially less likely to achieve VS and require targeted research and programmatic attention.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1464-2662 1468-1293
DOI:	10.1111/hiv.12397