Correlates of HIV detection among breastfeeding postpartum Kenyan women eligible under Option B+

Abstract

Background The Option B+ strategy streamlines delivery of HIV antiretroviral therapy (ART) to pregnant women, but concerns remain about ART treatment adherence and long term outcomes. Methods We conducted a retrospective analysis of a cohort of HIV-positive, postpartum breastfeeding women receiving ART via Option B+ in Nairobi, Kenya. The primary outcome was virologic failure in plasma (HIV RNA >1000 copies/mL), and detection in breast milk (>150 copies/mL) and endocervical secretions (>100 copies/mL) at 2 postpartum timepoints. Correlates of virologic failure were assessed using univariate tests and multivariate logistic regression. Results Of 42 women at 6–14 weeks postpartum, 21.4% of women had HIV RNA detected in plasma; 14.3% in breast milk, and 23.7% in endocervical secretions. At 18–24 weeks postpartum, the percentages were 21.1%, 7.1%, and 14.3%, respectively. Younger maternal age, intent to breastfeed for longer, and later ART start in pregnancy were significantly associated with plasma virologic failure (p < 0.05 for each). Odds of plasma virologic failure at 6–14 weeks postpartum were 1.25 times higher (95% CI 1.04, 1.51) for each increase in week of gestation at ART initiation. Only 3 women had resistance mutations to their regimen. Conclusions Despite months of ART, nearly one-quarter of the women in our cohort did not achieve plasma virologic suppression in the postpartum period. After adjusting for time on ART, earlier ART initiation in pregnancy was significantly associated with plasma suppression. Our findings suggest that postpartum HIV RNA monitoring in Option B+ programs will be needed to achieve elimination of MTCT.

Food insecurity, drug resistance and non-disclosure are associated with virologic non-suppression among HIV pregnant women on antiretroviral treatment

“…Our findings are consistent with other studies from SSA, which report 6-20% prevalence of virologic non-suppression among women on Option B+ [6,[27][28][29][30]. However, most of these studies evaluated VL postpartum following ART initiation in pregnancy, in contrast to our study which focused on pregnancy.…”

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

“…Accumulating evidence has shown that giving antiretroviral medicines to the mother or the infant significantly reduces the risk of HIV transmission through breastfeeding (98). A study by Chan et al (99) on HIV detection among 42 breastfeeding Kenyan women showed that at 6-14 wk postpartum, 21.4% had HIV RNA detected in plasma and 14.3% in breast milk. However, when adjusting the time of beginning ART, earlier ART initiation in pregnancy was significantly associated with plasma suppression of the virus.…”