Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment.

Content Provider	Europe PMC
Author	Baroncelli, Silvia Pirillo, Maria F. Tamburrini, Enrica Guaraldi, Giovanni Pinnetti, Carmela Antoni, Anna Degli Galluzzo, Clementina M. Stentarelli, Chiara Amici, Roberta Floridia, Marco
Copyright Year	2015
Abstract	Abstract There is limited information on full viral suppression and low-level HIV-RNA viremia in HIV-infected women at the end of pregnancy. We investigated HIV-RNA levels close to delivery in women on antiretroviral treatment in order to define rates of complete suppression, low-level viremia, and quantifiable HIV-RNA, exploring as potential determinants some clinical and viroimmunological variables. Plasma samples from a national study in Italy, collected between 2003 and 2012, were used. According to plasma HIV-RNA levels, three groups were defined: full suppression (target not detected), low-level viremia (target detected but <37 copies/ml), and quantifiable HIV-RNA (≥37 copies/ml). Multivariable logistic regression was used to define determinants of full viral suppression and of quantifiable HIV-RNA. Among 107 women evaluated at a median gestational age of 35 weeks, 90 (84.1%) had HIV-RNA <37 copies/ml. Most of them (59/90, 65.6%) had full suppression, with the remaining (31/90, 34.4%) showing low-level viremia (median: 11.9 copies/ml; IQR 7.4–16.3). Among the 17 women with quantifiable viral load, median HIV-RNA was 109 copies/ml (IQR 46–251), with only one case showing resistance (mutation M184V; rate: 9.1%). In multivariable analyses, women with higher baseline HIV-RNA levels and with hepatitis C virus (HCV) coinfection were significantly more likely to have quantifiable HIV-RNA in late pregnancy. Full viral suppression was significantly more likely with nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and significantly less likely with higher HIV-RNA in early pregnancy. No cases of HIV transmission occurred. In conclusion, HIV-infected pregnant women showed a high rate of viral suppression and a low resistance rate before delivery. In most cases no target HIV-RNA was detected in plasma, suggesting a low risk of subsequent virological rebound and development of resistance. Women with high levels of HIV-RNA in early pregnancy and those who have concomitant HCV infection should be considered at higher risk of having quantifiable HIV-RNA at the end of pregnancy.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC4505753&blobtype=pdf
Page Count	6
ISSN	08892229
Volume Number	31
DOI	10.1089/aid.2014.0288
PubMed Central reference number	PMC4505753
Issue Number	7
PubMed reference number	25769019
Journal	AIDS Research and Human Retroviruses [AIDS Res Hum Retroviruses]
e-ISSN	19318405
Language	English
Publisher	Mary Ann Liebert, Inc.
Publisher Date	2015-04-08
Publisher Place	USA
Access Restriction	Open
Rights License	Copyright 2015, Mary Ann Liebert, Inc.
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Virology Immunology