Viraemia before, during and after pregnancy in <scp>HIV</scp>‐infected women on antiretroviral therapy in rural KwaZulu‐Natal, South Africa, 2010–2015

Chetty, Terusha; Newell, Marie‐Louise; Thorne, Claire; Coutsoudis, Anna

doi:10.1111/tmi.13001

Cited by 30 publications

(30 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1] The goal of ART is to suppress maternal viral load (VL) to substantially lower risk of transmitting the virus to their infant during pregnancy [2][3][4][5][6] and breastfeeding. [7,8] However, in several Sub-Saharan African PMTCT study populations, the proportions of pregnant women with unsuppressed VL range from 6.1-15.4%, [9][10][11][12][13] with 9.4-22% experiencing postpartum episodes of virologic rebound [14,15]. This is consistent with the reported postpartum dropoff in Option B+ ART adherence.…”

Section: Introductionsupporting

confidence: 73%

Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

et al. 2020

View full text Add to dashboard Cite

Background Kenya's guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women. Method We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result. Results Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for 79 (19%). Only 115 women (27%) received a guideline-adherent baseline VL test and 27 (6%) received a guideline-adherent baseline and repeat VL test sequence. Return of baseline and repeat VL test results to the facility was high (average 96%), but patient notification of VL results was low (36% baseline and 49% repeat). Clinical action for unsuppressed VL results was even lower: 11 of 38 (29%) unsuppressed baseline results and 2 of 14 (14%) unsuppressed repeat results triggered clinical action. Discussion Guideline-adherent VL testing and clinical intervention during PMTCT must be prioritized to improve maternal care and reduce the risk of HIV transmission to infants.

show abstract

Section: Introductionsupporting

confidence: 73%

Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The main limiting factor is the lack of knowledge of the status of the disease prior to gestation. In 2018, in England only one-third of pregnant women undergo a prenatal screening for HIV, and in Canada for 2014, HIV, and 26% of pregnant women who had HIV were not aware of the status of their disease 6–8. In the case reported, the status of the disease was not known prior to gestation.…”

Section: Discussionmentioning

confidence: 98%

“…The measures that lower the risk of vertical transmission. Based on: Ministerio de Salud y Protección social1, The American College of Obstetricians and Gynecologists,4 Ministerio de Salud y Protección Social,5 Money et al ,6 British HIV Association,7 Chetty et al ,8 Roig et al 10 and Peters et al 12. ART, antiretroviral therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The fourth pillar is antiretroviral therapy (ART) management, which aims to reduce viral load by interrupting viral replication 8. ART should be initiated as soon as the diagnosis is made 1 5–7.…”

Section: Discussionmentioning

confidence: 99%

“…Initiating ART in pregnant women with HIV/AIDS is recommended regardless of the maternal viral load, and ideally between weeks 12 and 14 1 10. However, in 2018 the British HIV/AIDS Association recommended not to initiate ART until the second trimester unless the viral load is >100 000 copies/mL or the CD4 lymphocyte count is < 0.2×10 9 /L (200 cells/mm 3 ) 8. In the patient studied there were several indications for the initiation of ART1 6 7; however, there were done other interventions with intrapartum antiretroviral management due to the critical health state of the patient.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Preventive measures to avoid vertical transmission in untreated pregnant women with HIV/AIDS

et al. 2020

View full text Add to dashboard Cite

The HIV/AIDS during pregnancy has high morbidity and mortality, without optimal prevention and treatment. The advanced stage cases are found in developing countries due to late detection, but, also in developed countries due to immigration; therefore, the professionals should know the management steps for these patients. The implementation of specific interventions can reduce vertical transmission incidence until 1%–8%. It is presented a case of a pregnant woman with AIDS detected during first hospitalisation, due to a ventilatory failure by opportunistic germs; at the delivery the specific interventions were implemented, being able to eliminate vertical transmission to the newborn. This article explains the four main aspects to be considered for reducing vertical transmission (detection of HIV, viral load levels-CD4 lymphocyte count, way and moment of childbirth and antiretroviral therapy) and shares experiences of the management of an advanced case, in order to help professionals to handle these cases and its complications.

show abstract

Same‐day antiretroviral therapy (ART) initiation in pregnancy is not associated with viral suppression or engagement in care: A cohort study

et al. 2018

View full text Add to dashboard Cite

IntroductionMany prevention of mother‐to‐child HIV transmission programmes across Africa initiate HIV‐infected (HIV positive) pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care (“same‐day” initiation). However, there are concerns that same‐day initiation may limit patient preparation before starting ART and contribute to subsequent non‐adherence, disengagement from care and raised viral load. We examined if same‐day initiation was associated with viral suppression and engagement in care during pregnancy.MethodsConsecutive ART‐eligible pregnant women making their first antenatal care (ANC) visit at a primary care facility in Cape Town, South Africa were enrolled into a prospective cohort between March 2013 and June 2014. Before July 2013, ART eligibility was based on CD4 cell count ≤350 cells/μL (“Option A”), with a 1 to 2 week delay from the first ANC visit to ART initiation for patient preparation; thereafter all women were eligible regardless of CD4 cell count (“Option B+”) and offered ART on the same day as first ANC visit. Women were followed with viral load testing conducted separately from routine ART services, and engagement in ART services was measured using routinely collected clinic, pharmacy and laboratory records through 12 months postpartum.ResultsAmong 628 HIV‐positive women (median age, 28 years; median gestation at ART start, 21 weeks; 55% newly diagnosed with HIV), 73% initiated ART same‐day; this proportion was higher under Option B+ versus Option A (85% vs. 20%). Levels of viral suppression (viral load <50 copies/mL) at delivery (74% vs. 82%) and 12 months postpartum (74% vs. 71%) were similar under same‐day versus delayed initiation respectively. Findings were consistent when viral suppression was defined at <1000 copies/mL, after adjustment for demographic/clinical measures and across subgroups of age, CD4 and timing of HIV diagnosis. Time to first viral rebound following initial suppression did not differ by timing of ART initiation nor did engagement in care through 12 months postpartum (same‐day = 73%, delayed = 73%, p = 0.910).ConclusionsThese data suggest that same‐day ART initiation during pregnancy is not associated with lower levels of engagement in care or viral suppression through 12 months post‐delivery in this setting, providing reassurance to ART programmes implementing Option B+.

show abstract

Viraemia before, during and after pregnancy in HIV‐infected women on antiretroviral therapy in rural KwaZulu‐Natal, South Africa, 2010–2015

Cited by 30 publications

References 51 publications

Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

Preventive measures to avoid vertical transmission in untreated pregnant women with HIV/AIDS

Same‐day antiretroviral therapy (ART) initiation in pregnancy is not associated with viral suppression or engagement in care: A cohort study

Contact Info

Product

Resources

About