HIV-infected Ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods

Abstract

Background: HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on ART in Uganda. Methods:We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥ 1 pregnancy between 2005-2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters prior to pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or non-pregnancy-related. Regression models using GEE compared the likelihood of HIV-1 RNA ≤400 copies/mL, <80% average adherence based on electronic pill caps (MEMS), and likelihood of 72-hour medication gaps across each time period. Results: 111 women contributed 486 person-years of follow up. Viral suppression was present at 89% of non-pregnant, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (aOR 2.15) compared with non-pregnant periods. Average ART adherence was 90% (IQR 70-98%), 93% (IQR 82-98%), 92% (IQR 72-98%) and 92% (IQR 72-97%) during non-pregnant, periconception, pregnant and postpartum periods. Average adherence < 80% was less likely during periconception (aOR 0.68) and 72-hour gaps/90 days were less frequent during periconception (aRR 0.72) and more frequent postpartum (aRR 1.40). Conclusions: Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.