title: The Effects of Viral Load Burden on Pregnancy Loss among HIV-Infected Women in the United States.
abstract: BACKGROUND
  To evaluate the effects of HIV viral load, measured cross-sectionally and cumulatively, on the risk of miscarriage or stillbirth (pregnancy loss) among HIV-infected women enrolled in the Women's Interagency HIV Study between 1994 and 2013.
  
  
  METHODS
  We assessed three exposures: most recent viral load measure before the pregnancy ended, log10 copy-years viremia from initiation of antiretroviral therapy (ART) to conception, and log10 copy-years viremia in the two years before conception.
  
  
  RESULTS
  The risk of pregnancy loss for those with log10 viral load >4.00 before pregnancy ended was 1.59 (95% confidence interval (CI): 0.99, 2.56) times as high as the risk for women whose log10 viral load was ≤1.60. There was not a meaningful impact of log10 copy-years viremia since ART or log10 copy-years viremia in the two years before conception on pregnancy loss (adjusted risk ratios (aRRs): 0.80 (95% CI: 0.69, 0.92) and 1.00 (95% CI: 0.90, 1.11), resp.).
  
  
  CONCLUSIONS
  Cumulative viral load burden does not appear to be an informative measure for pregnancy loss risk, but the extent of HIV replication during pregnancy, as represented by plasma HIV RNA viral load, predicted loss versus live birth in this ethnically diverse cohort of HIV-infected US women.
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Cates
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Westreich
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Wright
authors.affiliation: Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.affiliation: Department of Obstetrics & Gynecology, Georgetown University, Washington, DC 20007, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Colie
authors.affiliation: Departments of Clinical Pharmacy, Medicine Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.affiliation: Department of Obstetrics and Gynecology, John H. Stroger Hospital of Cook County, Chicago, IL 60612, USA.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Cejtin
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA.
authors.forename: Roksana
authors.initials: R
authors.lastname: Karim
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Haddad
authors.affiliation: Schools of Nursing and Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
authors.forename: Mirjam-Colette
authors.initials: MC
authors.lastname: Kempf
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA ; School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000821:virology*; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000821:virology*; D011446:Prospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D014766:Viremia / Q000453:epidemiology / Q000821:virology*