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ART uptake increases among pregnant Chinese women
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Data from a recent meta-analysis suggest that the proportion of pregnant Chinese women with HIV who initiated ART has doubled within the past decade.
Despite this, proper adherence was only observed in approximately 75% of these women and remains a barrier to widespread viral suppression, the researchers wrote.
“HIV has advanced from high-risk groups, such as injecting drug users, female sex workers, and men who have sex with men, to the general population,” the researchers wrote. “According to recently reported data, the proportion of HIV-infected women has doubled over the last decade, and sexual transmission remains the main route of transmission. These data all suggest a continued risk of vertical transmission of HIV in China.”
Adherence issues challenge viral suppression
Researchers identified and examined 58 descriptive epidemiologic studies reporting ART use in pregnant women with HIV published between 2006 and 2015. Included studies covered all of the provinces in China, and did not involve experimental interventions to improve outcomes. Eligible articles were assessed and scored for quality using a standardized 11-item questionnaire. Outcomes of interest to the investigation included ART uptake during antenatal care or postnatal period; ART adherence; ART initiation during antenatal, intrapartum and postpartum periods; and reasons for not receiving ART.
The researchers found a pooled ART uptake rate of 74.3% (95% CI, 70.9-77.7), with yearly estimates increasing from 47.1% in 2006 to 95% in 2013. Women most often initiated ART during the antenatal period of their pregnancy, and cited emergency cesarean delivery as the leading reason for not initiating therapy. Uptake rates varied between regions of the country and was lowest in regions with higher incomes. In addition, adequate adherence to the treatment was reported among 76.7% of patients, prompting the researchers to suggest further action focusing on this area of Chinese HIV care.
“The ART adherence rate in HIV-infected pregnant women is significantly below that recommended for adequate virologic suppression, and optimal adherence remains a challenge in China,” the researchers wrote. “It is crucial to investigate specific barriers for lower ART uptake in the high income regions, monitor ART adherence and develop interventions to maintain the continuum of the integrated prevention of vertical transmission program and ensure the long-term efficacy of the prevention of vertical transmission program on the health of mothers and children.”
ART uptake, adherence influence viral load at delivery
The risk for vertical transmission is supported by data that suggest ART uptake and adherence also have an impact on an infected mother’s viral load at delivery.
In a recent multicenter observational study, Ingrid T. Katz, MD, MHS, assistant professor of medicine at Harvard Medical School and associate physician in the division of women’s health at Brigham and Women’s Hospital, and colleagues recruited 671 women enrolled in the IMPAACT Group Protocol 1025 from October 2002 to December 2011. The HIV-positive pregnant women were eligible if they were ART-naive before pregnancy, initiated ART during the index pregnancy and had viral load data within 14 days before delivery or 7 days after delivery.
Ingrid T. Katz
The researchers found that 13.1% of participating women had a detectable viral load at delivery. Among other factors, late initiation of ART, one or more treatment interruptions and nonadherence were associated with detectable viral load upon delivery. This trend also was seen among women receiving less potent regimens and women with higher pretreatment viral loads.
“These findings are important because they suggest that antiretroviral treatment can only achieve its optimal efficacy if HIV-positive individuals initiate treatment early and adhere to their medications throughout pregnancy,” Katz told Infectious Disease News. “They also underscore the importance of starting women on the most potent regimens available.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
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