Advertisement

20: Benefit of inter-pregnancy HIV viral load suppression on subsequent maternal and infant outcomes

      Objective

      To determine if inter-pregnancy HIV viral load suppression affects outcomes in subsequent pregnancies.

      Study Design

      This is a retrospective review of all women who delivered two consecutive pregnancies at our institution while diagnosed with HIV from January 1, 1984 until January 1, 2012. Medical records were reviewed for maternal, infant, and delivery data. Pregnancies were divided into first and second pregnancy, and inter-pregnancy interval was defined as the time from delivery of the first pregnancy to presentation of the second pregnancy.

      Results

      During the study period 172 HIV infected women were identified who delivered two pregnancies during the study period. There was no difference in median HIV viral load at presentation or delivery between first and second pregnancies. During the second pregnancy more women presented on antiretroviral therapy (ART) and more often remained compliant with ART, however the second pregnancy was associated with greater vertical transmission (3 v 6%, p=0.003). During the inter-pregnancy interval HIV viral loads increased by a median 182 copies/mL, and CD4 counts decreased by a median of 54. Of those with a viral load <1000 copies/mL at the end of their first pregnancy (N=103), 57 (55%) presented for their second pregnancy with viral loads still <1000 copies/mL. There was no difference in the inter-pregnancy interval between these groups. Those women who maintained viral load suppression between pregnancies were more likely to present for their second pregnancy on ART, maintained greater viral load suppression and CD4 counts at delivery, and had fewer vertical transmissions compared to those who re-presented with higher viral loads (0 vs. 7%, p=0.02).

      Conclusion

      Maintaining viral load suppression between pregnancies improves HIV disease status at delivery in subsequent pregnancies. Inter-pregnancy HIV viral load suppression is associated with less vertical transmission, emphasizing the importance of maintaining HIV disease control between pregnancies.
      Tabled 1
      Figure thumbnail fx1
      Data presented as N (%), mean ± SD, or median [Q1, Q3].