title: Benefit of interpregnancy HIV viral load suppression on subsequent maternal and infant outcomes.
abstract: OBJECTIVE
  The objective of the study was to determine whether interpregnancy human immunodeficiency virus (HIV) viral load suppression affects outcomes in subsequent pregnancies.
  
  
  METHODS
  This is a retrospective review of all women who delivered 2 consecutive pregnancies while diagnosed with HIV from Jan. 1, 1984, until Jan. 1, 2012. Medical records were reviewed for maternal, infant, and delivery data. Pregnancies were divided into index and subsequent pregnancy and analyzed for outcomes.
  
  
  RESULTS
  During the study period, 172 HIV-infected women who delivered 2 pregnancies at our institution were identified. There was no difference in median HIV viral load at presentation or delivery between the index and subsequent pregnancies. During the subsequent pregnancy, more women presented on antiretroviral therapy (ART) and more often remained compliant with ART; however, there was no difference in vertical transmission risk between the pregnancies. Of those with a viral load less than 1000 copies/mL at the end of their index pregnancy (n = 103), 57 (55%) presented for their subsequent pregnancy with a viral load still less than 1000 copies/mL. Those women who maintained the viral load suppression between pregnancies were more likely to present for their subsequent pregnancy on ART, maintained a greater viral load suppression and CD4 counts during the pregnancy, and had fewer vertical transmissions compared with those who presented with higher viral loads in their subsequent pregnancy (0% vs 9%, P = .02).
  
  
  CONCLUSIONS
  Maintaining an HIV viral load suppression between pregnancies is associated with improved HIV disease status at delivery in subsequent pregnancies. Interpregnancy HIV viral load suppression is associated with less vertical transmission, emphasizing the importance of maintaining HIV disease control between pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stewart
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: C Edward
authors.initials: CE
authors.lastname: Wells
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Roberts
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Rogers
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: McElwee
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Donald D
authors.initials: DD
authors.lastname: McIntire
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Sheffield
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV / Q000187:drug effects*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: human immunodeficiency virus in pregnancy; repeat pregnancy; viral load suppression