Time to Undetectable Viral Load after Highly Active Antiretroviral Therapy Initiation among HIV-Infected Pregnant Women

Patel, Darshak; Cortina‐Borja, Mario; Thorne, Claire; Newell, Marie‐Louise

doi:10.1086/518284

Cited by 92 publications

(37 citation statements)

References 31 publications

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“…It is not known the extent to which this is true, but there are a number of observations that support this assumption. In particular, infections with higher SPVL have been shown to retain a higher viral load when treated (Maldarelli et al., 2007; Marconi et al., 2011; Wright et al., 2014), require a longer duration of treatment to achieve virologic suppression (Manegold et al., 2004; Matthews et al., 2002; Mugavero et al., 2012; Paredes et al., 2000; Patel, Mario, Thorne, & Newell, 2007; Phillips et al., 2001; Rizzardi et al., 2000), be less likely to achieve complete virologic suppression (Bratt et al., 1998; Chaisson, Keruly, & Moore, 2000; Crawford, Sanderson, & Thornton, 2014; Knobel et al., 2001; Paredes et al., 2000) and be more likely to experience virologic failure (i.e., viral rebound despite adherence to ART; Egger et al., 2002; van Leth et al., 2005). Furthermore, SPVL rebounds rapidly when treatment is stopped (Davey et al., 1999; García et al., 1999; Ruiz et al., 2000) and typically to pretreatment levels (Hamlyn et al., 2012; Hatano et al., 2000; Oxenius et al., 2002).…”

Section: Discussionmentioning

confidence: 99%

Modelling the evolution of HIV‐1 virulence in response to imperfect therapy and prophylaxis

Mideo

2017

Evolutionary Applications

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Average HIV‐1 virulence appears to have evolved in different directions in different host populations since antiretroviral therapy first became available, and models predict that HIV drugs can select for either higher or lower virulence, depending on how treatment is administered. However, HIV virulence evolution in response to “leaky” therapy (treatment that imperfectly suppresses viral replication) and the use of preventive drugs (pre‐exposure prophylaxis) has not been explored. Using adaptive dynamics, we show that higher virulence can evolve when antiretroviral therapy is imperfectly effective and that this evolution erodes some of the long‐term clinical and epidemiological benefits of HIV treatment. The introduction of pre‐exposure prophylaxis greatly reduces infection prevalence, but can further amplify virulence evolution when it, too, is leaky. Increasing the uptake rate of these imperfect interventions increases selection for higher virulence and can lead to counterintuitive increases in infection prevalence in some scenarios. Although populations almost always fare better with access to interventions than without, untreated individuals could experience particularly poor clinical outcomes when virulence evolves. These findings predict that antiretroviral drugs may have underappreciated evolutionary consequences, but that maximizing drug efficacy can prevent this evolutionary response. We suggest that HIV virulence evolution should be closely monitored as access to interventions continues to improve.

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Section: Discussionmentioning

confidence: 99%

Modelling the evolution of HIV‐1 virulence in response to imperfect therapy and prophylaxis

Mideo

2017

Evolutionary Applications

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“…Prior studies have identified race-associated disparities in maternal HIV disease outcomes including high VL at delivery (16, 39–41). It is possible that experiences of race-based discrimination or lack of trust in the medical care system may pose barriers to engagement in care, which in turn could be associated with unsuppressed VL.…”

Section: Discussionmentioning

confidence: 99%

“…Viral suppression reduces MTCT risk and confers important benefits to maternal health both during and after pregnancy (12, 13). Factors associated with detectable VL (VL >400 copies/mL) at delivery include advanced HIV disease, late initiation of HAART, and inability to adhere to treatment (14–16). …”

Section: Introductionmentioning

confidence: 99%

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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“…Moreover, several observations had shown the need for a minimum of 12 weeks of effective antenatal antiretroviral treatment to control maternal viral load [18] [19].…”

Section: E N'guessan Et Al Open Journal Of Obstetrics and Gynecologymentioning

confidence: 99%

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

N'guessan¹,

Dia²,

Oyelade³

et al. 2017

OJOG

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Background: The elimination of HIV transmission from mother to child is currently possible. Côte d'Ivoire, which has a 4.6% HIV prevalence among women, is one of 22 pilot countries for the elimination of mother-to-child transmission of HIV. Since 2015, Côte d'Ivoire has adopted new strategies according to the WHO B+ guidelines. Objective: To identify factors associated with mother-to-child HIV transmission in children born of seropositive mothers managed at Treichville university hospital. Material and methods: A case-control study was conducted in the obstetrics department at Treichville university hospital, between January 2013 and December 2015. It involved children born to mothers infected with HIV, whose first PCR (Polymerase Chain Reaction) result was available during this period. A standardized questionnaire on data related to exposed children and their mother was used. Factors associated with mother-to-child HIV transmission were investigated using logistic regression. Results: A total of 214 HIV-exposed children were included in the study with a sex ratio of 0.9. The majority of the children were born by vaginal route (52.8%) and received post-exposure prophylaxis (88.3%) and replacement feed (51.9%). Their mothers received antiretroviral therapy during pregnancy in 45.3% of the cases. The first PCR was performed at the sixth week of life in 52.3% of cases. The prevalence of HIV infection in exposed children was 7.5% (95% CI = 4.5% -11.8%). In multivariate analysis, the absence of antiretroviral prophylaxis in children [aOR = 4.3, 95% (1.2 to 15.6), p = 0.03], the mixed feed [aOR = 3.8, 95% (1.1 -13.1), p < 0.03], the failure to take antiretroviral regimen during pregnancy [aOR = 8.0, 95% CI (1.9 -32.4), p < 0.003], were associated with mother-child HIV transmission. Conclusion: The mother-to-child HIV transmission rate remains high in our practice. Strategies to reduce situations that do not comply with current How to cite this paper:

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Time to Undetectable Viral Load after Highly Active Antiretroviral Therapy Initiation among HIV-Infected Pregnant Women

Abstract: In this study, nevirapine-based HAART (compared with PI [mainly nelfinavir]-based HAART), western African origin, and lower baseline viral load were associated with shorter time to achieving viral suppression.

Cited by 92 publications

References 31 publications

Modelling the evolution of HIV‐1 virulence in response to imperfect therapy and prophylaxis

Modelling the evolution of HIV‐1 virulence in response to imperfect therapy and prophylaxis

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

Mother-to-Child HIV Transmission Factors in Exposed Children at University Hospital Center of Treichville (Abidjan, Cote d’Ivoire)

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