Time to viral load suppression in antiretroviral‐naive and ‐experienced HIV‐infected pregnant women on highly active antiretroviral therapy: implications for pregnant women presenting late in gestation1. Issue 12 (7th August 2013)

• Record Type: Journal Article
• Authors: Aziz, N; Sokoloff, A; Kornak, J; Leva, NV; Mendiola, ML; Levison, J; Feakins, C; Shannon, M; Cohan, D
• Is Part Of: BJOG. Volume 120:Issue 12(2013:Dec.)
• Page Start: 1534
• Page End: 1547
• Publication Date: 2013-08-07
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12226
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12226-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12226-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare time to achieve viral load <400 copies/ml and <1000 copies/ml in HIV‐infected antiretroviral (ARV) ‐naive versus ARV‐experienced pregnant women on highly active antiretroviral therapy (HAART).</p> </sec> <sec id="bjo12226-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="bjo12226-sec-0003" sec-type="section"> <title>Setting</title> <p>Three university medical centers, USA.</p> </sec> <sec id="bjo12226-sec-0004" sec-type="section"> <title>Population</title> <p>HIV‐infected pregnant women initiated or restarted on HAART during pregnancy.</p> </sec> <sec id="bjo12226-sec-0005" sec-type="section"> <title>Methods</title> <p>We calculated time to viral load <400 copies/ml and <1000 copies/ml in HIV‐infected pregnant women on HAART who reported at least 50% adherence, stratifying based on previous ARV exposure history.</p> </sec> <sec id="bjo12226-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Time to HIV viral load <400 copies/ml and <1000 copies/ml.</p> </sec> <sec id="bjo12226-sec-0007" sec-type="section"> <title>Results</title> <p>We evaluated 138 HIV‐infected pregnant women, comprising 76 ARV‐naive and 62 ARV‐experienced. Ninety‐three percent of ARV‐naive women achieved a viral load < 400 copies/ml during pregnancy compared with 92% of ARV‐experienced women (<italic>P</italic> = 0.82). The median number of days to achieve a viral load < 400 copies/ml in the ARV‐naive cohort was 25.0 (range 3.5–133; interquartile range 16–34) days compared with 27.0 (range 8–162.5; interquartile range 18.5–54.3) days in the ARV‐experienced cohort (<italic>P</italic> = 0.02). In a multiple predictor analysis, women with higher adherence (adjusted relative hazard [aRH] per 10% increase in adherence 1.29, 95% confidence interval [CI] 1.08–1.54, <italic>P</italic> = 0.01) and receiving a non‐nucleotide reverse transcriptase inhibitor (NNRTI) ‐based regimen (aRH 2.48, 95% CI 1.33–4.63, <italic>P</italic> = 0.01) were more likely to achieve viral load <400 copies/ml earlier. Increased baseline HIV log<sub>10</sub> viral load was associated with a later time of achieving viral load <400 copies/ml (aRH 0.60, 95% CI 0.39–0.92, <italic>P</italic> = 0.02). In a corresponding model of time to achieve viral load <1000 copies/ml, adherence (aRH per 10% increase in adherence 1.79, 95% CI 1.34–2.39, <italic>P</italic> < 0.001), receipt of NNRTI (aRH 2.95, 95% CI 1.23–7.06, <italic>P</italic> = 0.02), and CD4 cell count (aRH per 50 count increase in CD4 1.12, 95% CI 1.03–1.22, <italic>P</italic> = 0.01) were associated with an earlier time to achieve viral load below this threshold. Increasing baseline HIV log<sub>10</sub> viral load was associated with a longer time of achieving viral load <1000 copies/ml (aRH 0.54, 95% CI 0.34–0.86, <italic>P</italic> = 0.01). In multiple predictor models, previous ARV exposure was not significantly associated with time to achieve viral load below thresholds of <400 copies/ml and <1000 copies/ml.</p> </sec> <sec id="bjo12226-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Pregnant women with ≥50% adherence, whether ARV‐naive or ARV‐experienced, on average achieve a viral load <400 copies/ml within a median of 26 days and a viral load of <1000 copies/ml within a median of 14 days of HAART initiation. Increased adherence, receipt of NNRTI‐based regimen and lower baseline HIV log<sub>10</sub> viral load were all statistically significant predictors of earlier time to achieve viral load <400 copies/ml and <1000 copies/ml. Increased CD4 count was statistically significant as a predictor of earlier time to achieve viral load <1000 copies/ml.</p> </sec> </abstract>