Treatment change in pregnancy is a significant risk factor for detectable HIV-1 RNA in plasma at end of pregnancy.
OBJECTIVE
To investigate the risk factors for an HIV-1 RNA plasma viral load above 400 copies/mL in the third trimester of pregnancy.


METHODS
Data from a large national study were used. The possible determinants were assessed in univariate analyses and in a multivariate logistic regression model in order to adjust for possible confounders.


RESULTS
Among 662 pregnancies followed between 2001 and 2008, 131 (19.8%) had an HIV-1 plasma copy number above 400/mL at the third trimester of pregnancy. In the multivariate analysis, the variables significantly associated with this occurrence were earlier calendar year (adjusted odds ratio [AOR] per additional calendar year, 0.70; 95% CI, 0.63-0.77; P<.001), lower CD4 count at enrollment (AOR per 100 cells lower, 1.18; 95% CI, 1.09-1.27; P<.001), HIV-1 RNA levels above 400 copies per mL at enrollment (AOR, 2.23; 95% CI, 1.50-3.33; P<.001), and treatment modification during pregnancy (AOR, 1.66; 95% CI, 1.07-2.57; P=.024).


CONCLUSIONS
Treatment changes in pregnancy significantly increase the risk of an incomplete viral suppression at the end of pregnancy. In HIV-infected women of childbearing age, proper preconception care, which includes the preferential prescription of regimens with the best safety profile in pregnancy, is likely to prevent an incomplete viral suppression at the end of pregnancy.
Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy. floridia@iss.it
Marco
M
Floridia
Marina
M
Ravizza
Carmela
C
Pinnetti
Cecilia
C
Tibaldi
Anna
A
Bucceri
Gianfranco
G
Anzidei
Marta
M
Fiscon
Atim
A
Molinari
Pasquale
P
Martinelli
Serena
S
Dalzero
Enrica
E
Tamburrini
D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D011263:Pregnancy Trimester, Third; D012367:RNA, Viral / Q000097:blood* / Q000187:drug effects; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load / Q000187:drug effects; D028761:Withholding Treatment; D055815:Young Adult
D044966:Anti-Retroviral Agents; D012367:RNA, Viral