Low detectable postpartum viral load is associated with HIV transmission in Malawi's prevention of mother-to-child transmission programme

1 INTRODUCTION In 2011, Malawi implemented 'Option B+,' a universal test and treat strategy for all pregnant and breastfeeding women for the prevention of mother-to-child-transmission (PMTCT) of HIV [1,2]. Option [...]
Introduction: In 2011, Malawi implemented "Option B+," a test-and-treat strategy for the prevention of maternal to child transmission of HIV (PMTCT); however limited data on viral load (VL) suppression exist. We describe VL suppression in HIV-infected women at four to twenty-six weeks postpartum, factors associated with VL suppression and the impact of VL suppression levels on MTCT. Methods: HIV-positive mothers at four to twenty-six weeks postpartum were enrolled in a nested cross-sectional study within the "National Evaluation of Malawi's PMTCT Programme" cohort study between October 2014 and May 2016. HIV-exposed infants received HIV-1 DNA testing and venous samples determined maternal VL, classified as unsuppressed (>1000 copies/mL), low-detectable (40 to 1000 copies/mL) or undetectable ( Conclusions: Unsuppressed and low-detectable VL was strongly predictive of MTCT among women on ART and associated with suboptimal adherence. This urges further consideration of optimal VL monitoring and target levels to reach elimination of paediatric infection. Keywords: viral load suppression; HIV; prevention of maternal to child transmission; antiretroviral therapy; HIV transmission; Option B+