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HAART decreased viral load in pregnant women
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Initiation of highly active antiretroviral therapy or short-term antiretroviral therapy during pregnancy may ensure safe vaginal delivery, depending on the mother’s baseline viral load, gestational age at start of treatment and type of therapy, according to data from a recent study.
Researchers collected data from 2000 to the present from five centers across London and the southeast of the United Kingdom and examined a retrospective cohort of women beginning HAART while pregnant. The researchers set out to determine what factors influenced the treatment’s effectiveness in preventing mother-to-child HIV transmission during vaginal delivery.
Inclusion criteria required women to have started one of the following forms of HAART: ritonavir-boosted protease inhibitor, non-nucleoside reverse transcriptase inhibitor or triple nucleoside reverse transcriptase inhibitor (NRTI). Additionally, women were only included if they had been assessed using a viral load assay with a lower limit of detection of <50 copies/mL.
Among these women, 378 qualified for analysis, according to the researchers, with boosted protease inhibitor–based HAART initiated at a median of 23.2 weeks gestation in 246 (65%) of women, NNRTI–based HAART in 129 (34%) and triple NRTI–based therapy in three (1%). Median pretreatment viral load was 8,243 copies/mL, and median pretreatment CD4 count was 330 cells/mm3.
Results revealed that by delivery date, 292 women (77.3%) reached a viral load <50 copies/mL after a median of 58 days of treatment. The researchers noted that baseline viral loads played a role in reaching a viral load <50 copies/mL. Data showed that a baseline viral load of <10,000 was associated with having a viral load <50 copies/mL in 91% of women by the time of delivery. For 10,000 to <50,000, it was 73%; for 50,000 to 100,000, 54% or >100,000, 37%.
In multivariate analysis, the researchers also said that an HR for an NNRTI regimen reaching a viral load <50 copies/mL was 0.7 when compared with the HR for protease inhibitor (95% CI, 0.52-0.94). However, when a viral load was >10,000, 58% of protease inhibitor and 66% of NNRTI regimens reached a viral load <50 copies/mL.
Although time of HAART initiation did not significantly affect viral load <10,000, the HR for having a viral load <50 copies/mL for women with baseline viral loads 10,000 to 50,000 decreased to 0.51 if HAART was started after 23.3 weeks compared with 0.1 when started after 20.4 weeks, according to the researchers. – by Melissa Foster
Read PJ. #896. Presented at: 17th Conference on Retroviruses and Opportunistic Infections; Feb. 16-19, 2010; San Francisco.