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Human immunodeficiency virus (HIV) viral load (VL) during pregnancy is a critical determinant of the risk of HIV mother-to-child transmission (MTCT). Prior studies suggest that VL suppression is influenced by antiretroviral regimen. In this study, using secondary real-life data from the Ministry of Health of Brazil, we compared VL suppression at 60-180 days after the first antiretroviral therapy (ART) prescription during pregnancy and time to undetectable VL among pregnant women under treatment with double nucleoside/nucleotide regimens combined with efavirenz, boosted lopinavir, boosted atazanavir, or raltegravir, with adjustment for potential confounders in multivariable models. A total of 18,997 pregnant women living with HIV were included in the study. Compared to regimens containing lopinavir, we found that atazanavir-, efavirenz-, and raltegravir-based regimens were superior in achieving both outcomes after adjustment for age, social vulnerability index, time under ART, baseline CD4+ cell count, and baseline HIV VL. Raltegravir-containing regimens had the highest adjusted odds/rates of VL suppression compared to patients with other regimens. Elimination of HIV MTCT is still a critical public health issue in many countries. Our findings suggest that raltegravir-based regimens were superior when compared to efavirenz-, lopinavir-, and atazanavir-based antiretroviral regimens in achieving suppression of HIV VL.

Objective: To identify clinical, sociodemographic, and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014-2015., Methods: Data from 4 information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving viral load suppression (VLS), defined as having either a viral load (VL) count >200 copies per milliliter or an aids-related death recorded within 180 ± 90 days after treatment initiation., Results: Among 76,950 individuals, 64.8% were men; median age, CD4, and VL counts were 34 years, 378 cells per micro liter, and 38,131 copies per milliliter, respectively, and 85.2% achieved VLS. In the multivariate analysis, some factors which increased the odds of non-VLS were as follows: lower CD4 and higher VL counts, younger age, heterosexual or injection drug use groups (relative to men who have sex with men), lower educational level, black/brown race, higher pill burden, and higher dosing frequency. Regimens containing boosted protease inhibitors were similar to those containing nonnucleoside reverse transcriptase inhibitors and superior to those containing unboosted protease inhibitors (all P values <0.001). No difference was observed between patients with CD4 counts 350-499 and 500+ cells per micro liter., Conclusions: Our findings support the decision made in Brazil in 2013 to recommend immediate initiation of ART regardless of clinical stage or CD4. Several factors were found to be associated with poorer virologic outcomes and should be addressed to maximize ART adherence and success rates.

The aim of this study was to identify sociodemographic factors associated with attrition in the 3 steps of the HIV continuum of care related to the 90-90-90 targets - access to diagnosis, treatment initiation, and virologic suppression, in Brazilian adults (15 years or older), in 2016.Programmatic data were obtained from 2 information systems from the Brazilian Ministry of Health, which register all antiretroviral therapy (ART) dispensations and all CD4 and viral load counts (VL) performed within the country's public health system. The 3 attrition indicators were late presentation to care, defined as a first CD4 count <350 cells/mm among ART-naive individuals who performed a first CD4 count in 2016; not being on ART, defined as having no recorded dispensation within the last 100 days of the year, among those who were linked to care in 2016; and not being virologically suppressed, defined as having the last recorded VL >200 copies/mL in 2016, among those with a recorded VL count who were on treatment for at least 6 months. Association of sociodemographic factors with these indicators was analyzed by unconditional logistic regression analysis.Lower educational level and black/brown/indigenous race/color were associated with worse outcomes in the 3 indicators. Environmental indicators, namely the region, size, and social vulnerability index of the municipality of residence, also played an important role in the models. Younger age was strongly associated with not being on ART and not showing virological suppression.Our findings help identify the barriers in the different stages of the HIV continuum of care, which need to be addressed in order to progress toward the achievement of the 90-90-90 targets.