Interpartum HIV viral load suppression improves outcomes

Image: PD 

1. Women who maintained viral load suppression between pregnancies were less likely to vertically transmit HIV to their infant. 

2. Women who maintained viral load suppression between pregnancies were more likely to have greater viral load suppression at the time of their 2^nd delivery. 

Evidence Rating Level: 2 (Good) 

Study Rundown: This study found that maintaining HIV viral load suppression between pregnancies reduces the risk of vertical transmission. While there is some evidence to suggest that treating HIV-positive women with antiretroviral therapy (ART) prior to conception reduces risk of mother-to-child transmission, research has not evaluated the benefit of treating women after delivery. The present work provides evidence that maintaining viral load suppression after delivery is beneficial in women who may become pregnant again in the future.

This study is limited by retrospective design, small sample size, and potential confounding by changes in recommendations for treatment over the study period. Additional investigation in prospective cohort studies is warranted to determine optimal care of HIV-positive women of childbearing potential.

Click to read the study in AJOG

Relevant Reading: Low rates of mother-to-child transmission of HIV following effective pregnancy interventions

Study Author, Dr. Robert Stewart, MD talks to 2 Minute Medicine: University of Texas Southwestern, Assistant Instructor, Department of Obstetrics & Gynecology

“Interpregnancy care and viral load suppression have a significant impact on both maternal and newborn health in subsequent pregnancies. Continuity of care is an important aspect in the care of HIV-infected individuals, and care of pregnancy begins before conception. Hopefully this research will provide more evidence to help strengthen the national recommendations for interpregnancy HIV care in reproductive age women.”

In-Depth [retrospective cohort]: This study evaluated the relationship between interpregnancy HIV viral load suppression and pregnancy outcomes in 172 HIV-positive women. Maintenance of viral load suppression was defined as viral load <1000 copies/mL at both the index delivery and the time of presentation for prenatal care for the 2^nd pregnancy. Outcomes evaluated included antiretroviral treatment, viral load suppression and CD4 counts during pregnancy and vertical transmissions.

Women who maintained interpregnancy viral load suppression <1000 copies/ml (n=57) had a lower median viral load (p<0.001) and higher CD4 count (p=0.004) at the time of diagnosis of their 2^nd pregnancy than women who did not maintain suppression (n=46). Women who maintained interpregnancy viral load suppression were less likely to vertically transmit HIV to their child (p=0.02)

More from this author: Low hCG in early pregnancy associated with preeclampsia, First trimester biomarkers screen for congenital heart defects, Cerclage outcomes similar in singleton and twin pregnancies, New sepsis scoring system aids in predicting morbidity in obstetric patients, Induction after 40 weeks in women with gestational diabetes associated with Cesarean delivery

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