HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods

Abstract

Background HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on ART in Uganda. Methods We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥ 1 pregnancy between 2005-2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters prior to pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or non-pregnancy-related. Regression models using GEE compared the likelihood of HIV-1 RNA ≤400 copies/mL, <80% average adherence based on electronic pill caps (MEMS), and likelihood of 72-hour medication gaps across each time period. Results 111 women contributed 486 person-years of follow up. Viral suppression was present at 89% of non-pregnant, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (aOR 2.15) compared with non-pregnant periods. Average ART adherence was 90% (IQR 70-98%), 93% (IQR 82-98%), 92% (IQR 72-98%) and 92% (IQR 72-97%) during non-pregnant, periconception, pregnant and postpartum periods. Average adherence < 80% was less likely during periconception (aOR 0.68) and 72-hour gaps/90 days were less frequent during periconception (aRR 0.72) and more frequent postpartum (aRR 1.40). Conclusions Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

A Systematic Review of the Current Status of Safer Conception Strategies for HIV Affected Heterosexual Couples in Sub-Saharan Africa

“…The same study found that pregnancy incidence was 10.2 per 100 person-years (n = 1785) in women on PrEP indicating that PrEP may be acceptable and feasible as a SCS in HIV-uninfected women with HIV-infected partners. Matthews et al found that Ugandan HIV-infected women trying to conceive had highest levels of ART adherence during peri-conception periods (adjusted odds ratio [aOR] 2.15, 95% CI 1.33, 3.49) when compared to non-pregnant women during a six-year study [58]. …”

“…Thirteen studies were qualitative assessments of healthcare providers and people living with HIV or serodiscordant couples. Several studies found that providers rarely initiated discussion of fertility intentions and reproductive goals with HIV-affected clients during visits [24, 39, 41, 42, 46, 50, 58, 65]. When fertility intentions were assessed, usually only the woman’s reproductive goals were discussed and not the man’s or couples [58, 61].…”

Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda

“…21 In contrast, a cohort in western Uganda reported that women who initiated ART for clinical indications (median CD4 count 165 cells/mm 3 ) were able to maintain high levels (>89%) of viral suppression to ≤400 copies/ml subsequently during pregnancy and up to 6 months postpartum. 22 …”

Timing of pregnancy, postpartum risk of virologic failure and loss to follow-up among HIV-positive women

“…Viral suppression rates decrease gradually from nonpregnant state to postpartum period [18]. Although the PMTCT programme coverage in South Africa has been successful in nearly eliminating MTCT, postpartum virologic suppression is the key for further reductions of postpartum transmission rates [20].…”