Predictors and Timing to Viral Suppression in HIV-Infected Pregnant Women in the University of Zimbabwe Birth Cohort Study During the Era of Lifelong Antiretroviral Therapy (Option B+ Treatment Strategy)

Abstract

BackgroundAchieving and maintaining viral suppression (VS) in people living with HIV/AIDS on antiretroviral therapy (ART) remains a crucial clinical goal, more so in pregnancy to prevent mother-to-child-transmission (MTCT). There is a need to understand VS kinetics and barriers to achieving it in order to meet the target of eliminating HIV-MTCT by 2030.MethodsHIV-infected pregnant women ≥20 weeks of gestation with different durations of Tenofovir/Lamivudine/Efavirenz exposures seeking antenatal care services at four primary health centres in high-density residential areas in Harare, Zimbabwe were enrolled in the University of Zimbabwe Birth Cohort Study. Plasma viral load (VL) was quantified by reverse transcriptase–polymerase chain reaction. Demographic, clinical, socio-economic and HIV- and ART-related factors were tested in multivariable logistic regression analyses as potential predictors for VS and undetectable VL.ResultsFrom March 2016 to June 2019, 608 HIV-infected pregnant women were enrolled. 63 (10.4%) were self-reported-ART-naïve; 324 (53.3%) and 221 (36.3%) initiated ART pre- and post-conception, respectively. Time from ART initiation to VS (VL ≤ 1,000 copies/ml) in 95% of the women was 126 days. Overall lack of VS (VL > 1,000 copies/ml) was observed in 133 (21.9%) women being 76.2, 27.4 and 7.7% in self-reported-ART-naïve, post-conception and pre-conception groups, respectively. Undetectable VL (≤ 50 copies/ml) was observed in 371 (61.2%) and low-level viremia (51–1,000 copies/ml) in 102 (16.8%) women.In multivariable models for all participants regardless of ART exposure, being on ART was the strongest predictor for both VS and undetectable VL (odds ratio 95% confidence interval, OR (CI): 8.9(4.2–19.5) and 8.1(3.2–24.4), respectively). For women on ART, duration of ART use >126 days was the strongest predictor with OR (CI): 6.7(3.3–14.0) for VS and 8.5(5.6–13.1) for undetectable VL. Other relevant predictors for favourable virological outcomes were older maternal age, HIV-status disclosure, absence of ART side effects and self-reported depression. Having a spouse/intimate partner on ART predicted a 4 times higher likelihood for VS.DiscussionLack of VS was frequently observed in this Harare cohort of pregnant women, mainly due to new HIV diagnosis, hence not being on ART and suboptimal duration of ART exposure. Since VS for 95% of women needed about 4 months of ART exposure, eliminating HIV-MTCT will require timely screening and commencing women together with their spouses/intimate partners on ART before pregnancy or early after conception.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT04087239.

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

“…Studies conducted in Uganda and Kenya found no association between the two ( 25 , 26 ). Even though studies conducted in Ghana and Zimbabwe found that longer duration was associated with higher levels of viral suppression, the cutoff duration points were 3 years and 4.5 months, respectively ( 27 , 28 ). From this, we can conclude that the cutoff duration points are inconsistent and there are no proper scientific explanations for the comparable durations.…”

Mother-to-Child Transmission of HIV Within 24 Months After Delivery in Women Initiating Lifelong Antiretroviral Therapy Pre/Post-Conception or Postnatally; Effects of Adolescent Girl and Young Woman Status and Plasma Viremia Late in Pregnancy

“…To investigate the role of ART, we categorized use as >126 days or sub-optimum (≤126 days) by the time of delivery as previously described (6). Differences in the groups of women; non-transmitters versus transmitters after stratification by timing of MTCT: IU, IP, and PP, were tested by Kruskal-Wallis, c 2 , or Fishers exact tests, where appropriate.…”

“…Date for ART commencement, compliance, and HIV status disclosure were recorded in HIV-infected women. According to the Zimbabwean national guidelines, all HIV-infected women should be on lifelong ART, but in practice, pregnant women often do not receive a timely HIV diagnosis (6). By then in 2016, the current standard of care for all HIVinfected pregnant women for PMTCT of HIV consisted of (non-)NRTIs, TENOLAM-E (Tenofovir, Lamivudine and Efavirenz).…”

“…HIV-infected pregnant women have been shown to have higher rates of adverse birth outcomes compared with their HIV-uninfected counterparts (3,4). Hence, undiagnosed maternal HIV mainly due to poor socialeconomic circumstances remains a challenge in both resource rich and limited settings, more so in adolescent girls and young women (AGYW) aged 15-24 years) (5)(6)(7).…”

Tenofovir Lamivudine Efavirenz Side Effect and Its Efficacy Among People Living with HIV in Jayapura

“…Previous studies reported the effectiveness of using LTE, such as a study in India reported the efficacy of using LTE was 98.7% and without major side effects [22], also in Africa, the use of LTE for more than 126 days showed virus suppression at undetectable levels [23]. The efficacy of TLE can be evaluated from the change of CD4 T lymphocyte count during therapy.…”