The risk of viral rebound in the year after delivery in women remaining on antiretroviral therapy
Author(s)
Type
Journal Article
Abstract
Objective: The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART).
Methods: Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50 copies/ml or less at delivery in 2006–2011, who started life-long cART during pregnancy (n = 321) or conceived on cART (n = 618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200 copies/ml) was assessed by Kaplan–Meier analysis; adjusted hazard ratios (aHRs) for the 0–3 and 3–12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.
Results: In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0–7.7] experienced viral rebound by 3 months, and 2.2% (1.4–3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58–4.39)] but not during the 3–12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22–32%) experienced viral rebound by 3 months, and 3.0% (1.6–4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58–12.29); 3–12 months: aHR 4.05 (2.03–8.09)].
Conclusion: In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.
Methods: Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50 copies/ml or less at delivery in 2006–2011, who started life-long cART during pregnancy (n = 321) or conceived on cART (n = 618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200 copies/ml) was assessed by Kaplan–Meier analysis; adjusted hazard ratios (aHRs) for the 0–3 and 3–12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models.
Results: In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0–7.7] experienced viral rebound by 3 months, and 2.2% (1.4–3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58–4.39)] but not during the 3–12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22–32%) experienced viral rebound by 3 months, and 3.0% (1.6–4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58–12.29); 3–12 months: aHR 4.05 (2.03–8.09)].
Conclusion: In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.
Date Issued
2015-11-30
Date Acceptance
2015-07-16
Citation
AIDS, 2015, 29 (17), pp.2269-2278
ISSN
0269-9370
Publisher
Wolters Kluwer
Start Page
2269
End Page
2278
Journal / Book Title
AIDS
Volume
29
Issue
17
Copyright Statement
© 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the
Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
License URL
Subjects
Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
adherence
HAART
HIV
postpartum women
pregnant women
viral load
HIV-ASSOCIATION GUIDELINES
INFECTED PREGNANT-WOMEN
HIV-1-POSITIVE ADULTS
POSITIVE WOMEN
POSTPARTUM
ADHERENCE
LOAD
CARE
TRANSMISSION
COMBINATION
UK Collaborative HIV Cohort (UK CHIC) Study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC)
06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status
Published