Risk Factors for Detectable HIV-1 RNA at Delivery Among Women Receiving Highly Active Antiretroviral Therapy in the Women and Infants Transmission Study

Katz, Ingrid T.; Shapiro, Roger; Li, Daner; Govindarajulu, Usha; Thompson, Bruce; Watts, D. Heather; Hughes, Michael D.; Tuomala, Ruth

doi:10.1097/qai.0b013e3181caea89

Cited by 42 publications

(33 citation statements)

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“…While this percentage of women with persistent viremia at delivery is concerning, this estimate is lower than the 24% of HAART-naive women with detectable VL at delivery observed in an earlier U.S. cohort (18). The timing of HAART initiation, along with consistent usage during pregnancy, were associated with VL at delivery.…”

Section: Discussioncontrasting

confidence: 54%

“…While one previous report showed virologic response to vary by regimen type (17), a large observational study found no difference in response by ARV regimen (18). A randomized trial of women with CD4+ ≥200 cells/μL in Botswana comparing the impact of a nucleoside reverse-transcriptase inhibitor [NRTI]-based regimen to a boosted protease-inhibitor [PI]-based regimen on VL at delivery observed high rates of virologic suppression at delivery and no difference between regimens (19).…”

Section: Introductionmentioning

confidence: 92%

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Factors Associated With Lack of Viral Suppression at Delivery Among Highly Active Antiretroviral Therapy–Naive Women With HIV

et al. 2015

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Background High delivery maternal plasma HIV-1 RNA level (viral load, VL) is a risk factor for mother to child transmission and poor maternal health. Objective To identify factors associated with detectable VL at delivery despite initiation of highly active antiretroviral therapy (HAART) during pregnancy. Design Multicenter observational study. Setting 67 US AIDS clinical research sites. Patients HIV-1-positive pregnant women who initiated HAART during pregnancy. Measurements Descriptive summaries and associations between socio-demographic, HIV disease, treatment and pregnancy-related risk factors and detectable VL (>400copies/mL) at delivery. Results Between October 2002 and December 2011, 671 women met inclusion criteria and 13% had detectable VL at delivery. Factors associated with detectable VL included multiparity (16.4% vs 8% nulliparous, p=0.002), black non-Hispanic ethnicity (17.6% vs 6.6% Hispanic and 6.6% white/non-Hispanic, p<0.001), 11th grade or less education (17.6% vs.12.1% high school graduate and 6.7% some college or higher, p=0.013), and initiation of HAART in third trimester (23.9% vs 12.3% second and 8.6% first, p=0.002), timing of HIV diagnosis prior to current pregnancy (16.1% vs 11% during current pregnancy, p=0.051), and timing of first prenatal visit in 3rd trimester (33.3% vs 14.3% second and 10.5% first, p=0.002). Women who experienced treatment interruptions or reported poor medication adherence during pregnancy were more likely to have detectable VL at delivery than women with no interruptions or who reported better adherence. Limitations Women entered the study at varying times during pregnancy and for this and other reasons there was incomplete data on many covariates. Conclusions In this large U.S.-based cohort of HIV-1 positive women, 13% of women who initiated HAART during pregnancy had detectable VL at delivery. The timing of HAART initiation and prenatal care along with medication adherence during pregnancy appear to be modifiable factors associated with detectable VL at delivery. Social factors such as Black/non-Hispanic ethnicity and less than high school education may help to identify women at highest risk who may benefit from focused efforts to promote early treatment initiation and adherence to HAART. Clinical Trial Registration Number NCT00028145

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 92%

Factors Associated With Lack of Viral Suppression at Delivery Among Highly Active Antiretroviral Therapy–Naive Women With HIV

et al. 2015

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“…Of these, only one delivered vaginally. Employing the current BHIVA guidance could signifi cantly reduce the number of women having CS due to isolated low-level detectable viraemia and hence improved measures for virological control is essential (Katz et al 2010).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes of HIV-positive women in a tertiary centre in the UK

Pammi

Carlin

2014

Journal of Obstetrics and Gynaecology

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With the advent of highly active antiretroviral therapy (HAART), the mother-to-child HIV transmission rate in the UK has reduced to less than 2%. A review of delivery outcomes of 106 HIV-positive pregnant women in a tertiary centre between January 2005 and December 2010 was conducted. A total of 20 women had detectable plasma viral load at 36 weeks, or before in the two women who delivered preterm. Various peripartum management measures were undertaken in women with detectable viral load close to delivery, to accelerate reduction in plasma viral load and to reduce the risk of HIV transmission to the fetus. In our review, the overall mother-to-child transmission rate was less than 1% and in women with undetectable viral load at 36 weeks, it was 0% (zero), which signifies the importance of strict virological control and a multidisciplinary approach, which plays an important role in the successful achievement of this.

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“…Rates of substance use in this population have historically been high; in the late 1980s and early 1990s, half of HIV-infected pregnant women used illicit substances [3, 4]. Substance use during pregnancy in HIV-infected women has negative implications for transmission [5–8], infant outcomes [9–19], and the health of the mother [20]. …”

Section: Introductionmentioning

confidence: 99%

Dramatic decline in substance use by HIV-infected pregnant women in the United States from 1990 to 2012

Rough

Tassiopoulos²,

Kacanek³

et al. 2015

Aids

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Objective We aimed to describe temporal changes in substance use among HIV-infected pregnant women in the US from 1990–2012. Design Data came from two prospective cohort studies (Women and Infants Transmission Study and Surveillance Monitoring for Antiretroviral Therapy Toxicities Study). Methods Women were classified as using a substance during pregnancy if they self-reported use or had a positive biological sample. To account for correlation between repeated pregnancies by the same woman, GEE models were used to test for temporal trends and evaluate predictors of substance use. Results Over the 23-year period, substance use among the 5,451 HIV-infected pregnant women sharply declined; 82% of women reported substance use during pregnancy in 1990, compared to 23% in 2012. Use of each substance decreased significantly (p<0.001 for each substance) in an approximately linear fashion, until reaching a plateau in 2006. Multivariable models showed substance use was inversely associated with receiving antiretroviral therapy. Among the subset of 824 women with multiple pregnancies under observation, women who used a substance in their previous pregnancy were at elevated risk of substance use during their next pregnancy (RR, 5.71; 95% CI, 4.63–7.05). Conclusions A substantial decrease in substance use during pregnancy was observed between 1990 and 2012 in two large US cohorts of HIV-infected women. Substance use prevalence in these cohorts became similar to that of pregnant women in the general US population by the mid-2000s, suggesting that the observed decrease may be due to an epidemiological transition of the HIV epidemic among women in the US.

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Risk Factors for Detectable HIV-1 RNA at Delivery Among Women Receiving Highly Active Antiretroviral Therapy in the Women and Infants Transmission Study

Cited by 42 publications

References 20 publications

Factors Associated With Lack of Viral Suppression at Delivery Among Highly Active Antiretroviral Therapy–Naive Women With HIV

Factors Associated With Lack of Viral Suppression at Delivery Among Highly Active Antiretroviral Therapy–Naive Women With HIV

Pregnancy outcomes of HIV-positive women in a tertiary centre in the UK

Dramatic decline in substance use by HIV-infected pregnant women in the United States from 1990 to 2012

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