title: Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment.
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.
authors.affiliation: 1 Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroncelli
authors.affiliation: 1 Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Maria F
authors.initials: MF
authors.lastname: Pirillo
authors.affiliation: 2 Department of Infectious Diseases, Catholic University , Rome, Italy .
authors.forename: Enrica
authors.initials: E
authors.lastname: Tamburrini
authors.affiliation: 3 Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: 4 I.N.M.I. Lazzaro Spallanzani , Rome, Italy .
authors.forename: Carmela
authors.initials: C
authors.lastname: Pinnetti
authors.affiliation: 5 Department of Infectious Diseases and Hepatology, Azienda Ospedaliera, Parma, Italy .
authors.forename: Anna
authors.initials: A
authors.lastname: Degli Antoni
authors.affiliation: 1 Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Clementina M
authors.initials: CM
authors.lastname: Galluzzo
authors.affiliation: 3 Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia , Modena, Italy .
authors.forename: Chiara
authors.initials: C
authors.lastname: Stentarelli
authors.affiliation: 1 Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Roberta
authors.initials: R
authors.lastname: Amici
authors.affiliation: 1 Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità , Rome, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Floridia
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007558:Italy; D010949:Plasma / Q000821:virology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D012367:RNA, Viral / Q000097:blood*; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis*
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral