1. An observational study of initial HIV RNA decay following initiation of combination antiretroviral treatment during pregnancy
- Author
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Sarah Chitty, David A. Hawkins, Yvonne Gilleece, Rosanna E Grimes, Helen Peters, Rimi Shah, Natasha Kay, Brenton C Wait, Fionnuala Finnerty, Sarah Parry, Mags Portman, Graham P. Taylor, Achyuta V Nori, Liat Sarner, Anna Hartley, Sherie Roedling, Kate Francis, Jasmini Alagaratnam, Melanie Rosenvinge, and Rebecca Marcus
- Subjects
0301 basic medicine ,Cart ,Adult ,lcsh:Immunologic diseases. Allergy ,medicine.medical_specialty ,Monitoring ,Anti-HIV Agents ,RNA Stability ,030106 microbiology ,Integrase inhibitor ,HIV Infections ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Antiretroviral Therapy, Highly Active ,Virology ,medicine ,Humans ,Pharmacology (medical) ,Protease inhibitor (pharmacology) ,030212 general & internal medicine ,London HIV Perinatal Research Group ,Retrospective Studies ,Transmission (medicine) ,business.industry ,Research ,virus diseases ,Treatment outcomes ,Viral Load ,medicine.disease ,Reverse transcriptase ,Infectious Disease Transmission, Vertical ,United Kingdom ,CD4 Lymphocyte Count ,Antiretroviral therapy ,Novel observations ,Logistic Models ,nervous system ,1107 Immunology ,Molecular Medicine ,Gestation ,RNA, Viral ,Observational study ,Female ,business ,lcsh:RC581-607 ,Half-Life - Abstract
Background In pregnancy, reduction of HIV plasma viral load (pVL) for the prevention of vertical transmission is time-constrained. The study primary objective is to investigate factors associated with faster initial HIV RNA half-life decay when combination antiretroviral treatment (cART) is initiated in pregnancy. Methods This was a multicentre, retrospective, observational study, conducted in south England, United Kingdom, between August 2001 and February 2018. Data were extracted from case notes of eligible women initiating cART during the index pregnancy. Anonymised data were collated and analysed centrally. Regression analyses were conducted to determine factors associated with faster HIV RNA half-life decay in the first 14 days after commencing cART (first-phase), and with achieving an undetectable maternal pVL by 36 weeks’ gestation. We then assessed whether HIV- and obstetric- related parameters differed by antiretroviral third agent class and whether the proportions of women with undetectable pVL at 36 weeks’ gestation and at delivery differed by antiretroviral third agent class. Results Baseline pVL was the only independent factor associated with faster first-phase HIV RNA half-life decay on commencing cART. Lower pVL on day 14 after starting cART was associated with an increased likelihood of achieving an undetectable pVL by 36 weeks’ gestation. Integrase inhibitor-based cART was associated with a faster first-phase HIV RNA half-life decay on commencing cART. Overall, 73% and 85% of women had an undetectable pVL at 36 weeks’ gestation and at delivery respectively, with no significant difference by antiretroviral third agent class. Conclusions Only high baseline pVL independently contributed to a faster rate of first-phase viral half-life decay. pVL at 14 days after initiating cART allows early identification of treatment failure. In the first 14 days after initiating cART in pregnancy, integrase inhibitor-based cART reduced maternal pVL faster than protease inhibitor- and non-nucleoside reverse transcriptase-based cART. While our study findings support INSTI use when initiated in pregnancy especially when initiated at later gestations and in those with higher baseline pVL, other non-INSTI based cART with more data on safety in pregnancy also performed well.
- Published
- 2020
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