Antiretroviral adherence during pregnancy and postpartum in Latin America.
Adherence to antiretrovirals by pregnant women (and postpartum women if breastfeeding) is crucial to effectively decrease maternal viral load and decrease the risk of mother-to-child transmission of HIV. Our objectives were to describe self-reported adherence to antiretrovirals during the antepartum (after 22 weeks of pregnancy) and postpartum periods (6-12 weeks and 6 months), and identify predictors of adherence among HIV-infected women enrolled and followed in a prospective cohort study from June 2008 to June 2010 at multiple sites in Latin America. Adherence was evaluated using the number of missed and expected doses during the 3 days before the study visit. At the pre-delivery visit, 340 of 376 women (90%) reported perfect adherence. This rate significantly decreased by 6-12 weeks (171/214 [80%]) and 6 months postpartum (163/199 [82%], p<0.01). The odds for less than perfect adherence at the pre-delivery visit was significantly higher for pregnant women with current tobacco use (odds ratio [OR]=2.9, 95% confidence interval [CI]: 1.46-6.14; p=0.0029). At 6-12 weeks postpartum, the probability of non-perfect adherence increased by 6% for each 1 year increase in age (OR=1.06, 95% CI: 1.00-1.12, p=0.0497). At 6 months postpartum, the odds of nonperfect adherence was higher for those who were currently using alcohol (OR=3.04, 95% CI: 1.34-6.90; p=0.0079). Although a self-report measure of adherence based on only 3 days may lead to overestimation of actual adherence over time, women with perfect adherence had lower viral loads and higher CD4 counts. Adherence to antiretrovirals decreased significantly postpartum. Interventions should target women at high risk for lower adherence during pregnancy and postpartum, including tobacco and alcohol users.
Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil. regis.kr@terra.com.br
Regis
R
Kreitchmann
D Robert
DR
Harris
Fabiana
F
Kakehasi
Jessica E
JE
Haberer
Pedro
P
Cahn
Marcelo
M
Losso
Elizabete
E
Teles
Jose H
JH
Pilotto
Cristina B
CB
Hofer
Jennifer S
JS
Read
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007843:Latin America / Q000453:epidemiology; D055118:Medication Adherence / Q000523:psychology; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D019562:Viral Load; D016903:Drug Monitoring
D019380:Anti-HIV Agents