title: Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study.
abstract: There are limited viral load (VL) data available from programs implementing "Option B+," lifelong antiretroviral treatment (ART) to all HIV-positive pregnant and postpartum women, in resource-limited settings. Extent of viral suppression from a prevention of mother-to-child transmission of HIV program in Rwanda was assessed among women enrolled in the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. ARV drug resistance testing was conducted on women with VL>2000 copies/ml. In April 2013-January 2014, 608 pregnant or early postpartum HIV-positive women were enrolled in 14 facilities. Factors associated with detectable enrollment VL (>20 copies/ml) were examined using generalized estimating equations. The most common antiretroviral regimen (56.7%, 344/607) was tenofovir/lamivudine/efavirenz. Median ART duration was 13.5 months (IQR 3.0-48.8); 76.1% of women were on ART at first antenatal visit. Half of women (315/603) had undetectable RNA-PCR VL and 84.6% (510) had <1,000 copies/ml. Detectable VL increased among those on ART > 36 months compared to those on ART 4-36 months (72/191, 37.7% versus 56/187, 29.9%), though the difference was not significant. The odds of having detectable enrollment VL decreased significantly as duration on ART at enrollment increased (AOR = 0.99, 95% CI: 0.9857, 0.9998, p = 0.043). There was a higher likelihood of detectable VL for women with lower gravidity (AOR = 0.90, 95% CI: 0.84, 0.97, p = 0.0039), no education (AOR = 2.25, (95% CI: 1.37, 3.70, p = 0.0004), nondisclosure to partner (AOR = 1.97, 95% CI: 1.21, 3.21, p = 0.0063) and side effects (AOR = 2.63, 95% CI: 1.72, 4.03, p<0.0001). ARV drug resistance mutations were detected in all of the eleven women on ART > 36 months with genotyping available. Most women were receiving ART at first antenatal visit, with relatively high viral suppression rates. Shorter ART duration was associated with higher VL, with a concerning increasing trend for higher viremia and drug resistance among women on ART for >3 years.
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Gill
authors.affiliation: Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Hoffman
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Bobrow
authors.affiliation: Rwanda Ministry of Health, Kigali, Rwanda.
authors.forename: Placidie
authors.initials: P
authors.lastname: Mugwaneza
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda.
authors.forename: Dieudonne
authors.initials: D
authors.lastname: Ndatimana
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Kigali, Rwanda.
authors.forename: Gilles F
authors.initials: GF
authors.lastname: Ndayisaba
authors.affiliation: University of Maryland, Baltimore, Maryland, United States of America.
authors.forename: Cyprien
authors.initials: C
authors.lastname: Baribwira
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America.|Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Guay
authors.affiliation: Rwanda University Teaching Hospitals, Kigali, Rwanda.
authors.forename: Anita
authors.initials: A
authors.lastname: Asiimwe
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012432:Rwanda; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents