Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

Abstract

Introduction The objective of the study was to determine HIV-1 RNA load profile during pregnancy and assess the eligibility for the maternal triple antiretroviral prophylaxis. It was an observational cohort of pregnant HIV positive women ignorant of antiretroviral therapy with CD4 cell count of>350/mm 3 Methods Routine CD4 cell count assessment in HIV positive pregnant women completed by non exclusive measurement of the viral load by PCR /ARN in those with CD4 cell count>350/mm 3 . Exclusion criteria: highly active antiretroviral therapy prior to pregnancy. Results Between January and December 2010, CD4 cell count was systematically performed in all pregnant women diagnosed as HIV-infected (n=266) in a referral center of 25 antenatal clinics. 63% (N=170) had CD4 cell count>350/mm 3 , median: 528 (IQR: 421–625). 145 underwent measurement of viral load by PCR/RNA at a median gestational of 23 weeks of pregnancy (IQR: 19–28). Median viral load 4.4log 10 /ml, IQR (3.5–4.9).19/145(13%) had an undetectable viral load of=1.8log 10 /ml. 89/145(61%) had a viral load of=4 log 10 /ml and were eligible for maternal triple ARV prophylaxis. Conclusion More than 6 in 10 pregnant HIV positive women with CD4 cell count of>350/mm 3 may require triple antiretroviral for prophylaxis of MTCT. Regardless of cost, such results are conclusive and may be considered in HIV high burden countries for universal access to triple antiretroviral prophylaxis in order to move towards virtual elimination of HIV MTCT.

Time for Option B+? Prevalence and Characteristics of HIV Infection among Attendees of 2 Antenatal Clinics in Buea, Cameroon

“…11 Our findings also revealed that the majority of the sero-positive participants were infected with HIV-1, a similar finding from other reports in Cameroon, which demonstrated that HIV-1 is the predominant type in the country. 15,16 The mean CD4 count of 546 (+179) cells/mm 3 was similar to those obtained from studies in Yaoundé, Cameroon, 17 and North-Rift, Kenya. 12 The relatively high mean CD4 count in the majority of the sero-positive participants may be indicative of recent HIV infection.…”

“…9 The mean viral load (at log 10 4.4 copies/mL) was similar to that reported by Njom Nlend in 2011 in Yaoundé. 17 We found that 7 of 10 sero-positive pregnant women who were on ARVs before enrollment were experiencing virological failure. This finding poses a significant obstacle in the management of sero-positive pregnant women, especially as viral load testing still remains a scarce and expensive laboratory examination in this part of the world.…”