Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment

Abstract

There is limited information on full viral suppression and low-level HIV-RNA viremia in HIV-infected women at the end of pregnancy. We investigated HIV-RNA levels close to delivery in women on antiretroviral treatment in order to define rates of complete suppression, low-level viremia, and quantifiable HIV-RNA, exploring as potential determinants some clinical and viroimmunological variables. Plasma samples from a national study in Italy, collected between 2003 and 2012, were used. According to plasma HIV-RNA levels, three groups were defined: full suppression (target not detected), low-level viremia (target detected but <37 copies/ml), and quantifiable HIV-RNA (≥37 copies/ml). Multivariable logistic regression was used to define determinants of full viral suppression and of quantifiable HIV-RNA. Among 107 women evaluated at a median gestational age of 35 weeks, 90 (84.1%) had HIV-RNA <37 copies/ml. Most of them (59/90, 65.6%) had full suppression, with the remaining (31/90, 34.4%) showing low-level viremia (median: 11.9 copies/ml; IQR 7.4-16.3). Among the 17 women with quantifiable viral load, median HIV-RNA was 109 copies/ml (IQR 46-251), with only one case showing resistance (mutation M184V; rate: 9.1%). In multivariable analyses, women with higher baseline HIV-RNA levels and with hepatitis C virus (HCV) coinfection were significantly more likely to have quantifiable HIV-RNA in late pregnancy. Full viral suppression was significantly more likely with nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and significantly less likely with higher HIV-RNA in early pregnancy. No cases of HIV transmission occurred. In conclusion, HIV-infected pregnant women showed a high rate of viral suppression and a low resistance rate before delivery. In most cases no target HIV-RNA was detected in plasma, suggesting a low risk of subsequent virological rebound and development of resistance. Women with high levels of HIV-RNA in early pregnancy and those who have concomitant HCV infection should be considered at higher risk of having quantifiable HIV-RNA at the end of pregnancy.

Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study

“…Low levels of retention can undermine the desired effectiveness of the Uganda PMTCT program in a number of ways. Failure to become virally suppressed increases the possibility of transmitting HIV to an infant through breastfeeding, and places children at risk of perinatal infection [ 31 ]. Women who do not remain on ART may also develop symptomatic HIV disease, transmit HIV to uninfected sexual partners, and develop drug resistance, particularly if they are taking ART intermittently [ 9 , 32 ].…”

Predictors of Attrition from Care and Treatment Centres among HIV-positive Pregnant and Breastfeeding Adult Women in Dar es Salaam, Tanzania

“…Sikazwe et al (2019) published a similar report. Failure to achieve viral suppression raises the chance of HIV transmissions to an infant through nursing, putting children at risk of perinatal infections (Baroncelli et al 2015). According to Sikazwe et al (2019), 71.3% of those who were lost had high viremia compared to those who were retained.…”

“…Low levels of retention, according to Nachega et al (2012), are one of the primary reasons for virologic failure and MTCT. Women who do not achieve viral suppression may develop symptomatic HIV illness, increasing the risks of HIV transmissions to uninfected sexual partners and infants through breastfeeding (Baroncelli et al 2015). So, it is important to figure out how to measure PMTCT retention in care and talk about what it means for clinical outcomes.…”