title: Predictive factors of plasma HIV suppression during pregnancy: a prospective cohort study in Benin.
abstract: OBJECTIVE
  To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin.
  
  
  METHODS
  Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT.
  
  
  METHODS
  HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy.
  
  
  RESULTS
  Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression.
  
  
  CONCLUSIONS
  This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.
authors.affiliation: UMR 216, Institut de Recherche pour le Développement and Université Paris Descartes, Paris, France. lisedenoeud@yahoo.fr
authors.forename: Lise
authors.initials: L
authors.lastname: Denoeud-Ndam
authors.forename: Camille
authors.initials: C
authors.lastname: Fourcade
authors.forename: Aurore
authors.initials: A
authors.lastname: Ogouyemi-Hounto
authors.forename: Angèle
authors.initials: A
authors.lastname: Azon-Kouanou
authors.forename: Marcelline
authors.initials: M
authors.lastname: d'Almeida
authors.forename: Alain
authors.initials: A
authors.lastname: Azondékon
authors.forename: Marouf J
authors.initials: MJ
authors.lastname: Alao
authors.forename: Véronique
authors.initials: V
authors.lastname: Dossou-Gbété
authors.forename: Aldric
authors.initials: A
authors.lastname: Afangnihoun
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.forename: Michel
authors.initials: M
authors.lastname: Cot
authors.forename: Djimon-Marcel
authors.initials: DM
authors.lastname: Zannou
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology*; D001541:Benin; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016015:Logistic Models; D008288:Malaria / Q000517:prevention & control; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011263:Pregnancy Trimester, Third / Q000097:blood; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
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