Long-acting treatment benefits postpartum women with HIV and their babies
Key takeaways:
- Switching to LA-ART at delivery could significantly reduce infant infections by about 160 each year.
- LA-ART could also improve infant health outcomes and be cost saving.
SAN FRANCISCO — Switching to long-acting ART from oral treatments was cost effective for postpartum women with HIV and improved infant outcomes, researchers said at the Conference on Retroviruses and Opportunistic Infections.
“Postpartum women with HIV face unique challenges to adhering to daily oral medications,” Andrea L. Ciaranello, MD, MPH, infectious disease physician at Massachusetts General Hospital and professor of medicine at Harvard Medical School, told Healio.
“This cannot only put their own health at risk but also markedly increase the risk of transmitting HIV to their infants through breastfeeding. New long-acting injectable ART medications may greatly benefit both women and infants,” she said.
This led Ciaranello and colleagues to initiate a study assessing the clinical outcomes and cost-effectiveness of long-acting ART (LA-ART) for breastfeeding postpartum women with HIV in Zimbabwe who faced adherence challenges to oral ART — something that both colleagues in Zimbabwe and an NIH-supported clinical trials group had reached out about studying, according to Ciaranello.
For the study, the researchers simulated two cohorts of women engaged in antenatal care who had adherence challenges while prescribed oral tenofovir/lamivudine/dolutegravir (TLD) during pregnancy. The first cohort included women who were not virally suppressed at the time of delivery and the second was women with viral suppression at delivery. Both cohorts also included their babies.
According to the study, the researchers modeled two ART approaches after delivery — standard of care, defined as continuation of TLD, and LA-ART, defined as switching from TLD to long-acting cabotegravir/rilpivirine (LA-CAB/RPV).
The study revealed that switching to LA-CAB/RPV at delivery for breastfeeding women with a history of adherence challenges to oral ART could significantly reduce infant infections, “potentially averting around 160 infant infections per year in Zimbabwe,” according to Ciaranello.
Specifically, data showed that LA-ART reduced projected vertical transmission compared with the standard of care, reducing rates from 8.07% to 6.59% for nonvirally suppressed women and from 4.18% to 3.81% among virally suppressed women.
The study also showed that for women who had not achieved viral suppression at delivery despite being engaged in care and prescribed ART, switching to cabotegravir/rilpivirine could improve infant health outcomes and be cost saving. Among these women, LA-ART improved pediatric life expectancy from 65.93 years for standard of care treatment to 66.37 years for LA-ART, while saving money ($770 per child for standard of care vs. $760 per child for LA-ART).
The study also showed, however, that for women who were virally suppressed at delivery but still had adherence issues, switching to cabotegravir/rilpivirine was actually not cost effective by international standards in Zimbabwe. According to the study, LA-ART led to higher projected pediatric life expectancy (67.51 years) and costs ($550 per child) than standard of care (67.39 years and $450 per child) for these women, with incremental cost-effectiveness ratios of $2,500 per life-year saved. The researchers added that LA-ART would become cost effective only if CAB/RPV cost less than $7 per month.
“Our findings indicate that postpartum women should be prioritized for access to long-acting ART. Long-acting ART cannot only improve the health of postpartum women with HIV but also reduce HIV transmission during breastfeeding, a challenging time for ART adherence,” Ciaranello said.
“Future studies on long-acting regimens should include postpartum women and include agreements to make these medications available at low cost to the communities that would benefit the most,” she said.
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Tewari S, et al. Abstract 1014. Presented at: Conference on Retroviruses and Opportunistic Infections; March 9-12, 2025; San Francisco.
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