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Human Immunodeficiency Virus Viral Load Rebound Near Delivery in Previously Suppressed, Combination Antiretroviral Therapy–Treated Pregnant Women

Boucoiran, Isabelle MD, MSc; Albert, Arianne Y. K. PhD; Tulloch, Karen PharmD; Wagner, Emily C. MSc; Pick, Neora MD; van Schalkwyk, Julie MD; Harrigan, P. Richard MD; Money, Deborah MD

doi: 10.1097/AOG.0000000000002133
Contents: Original Research

OBJECTIVE: To assess the stability of human immunodeficiency virus (HIV) viral load suppression within 1 month before birth in pregnant women receiving antenatal combination antiretroviral therapy (CART).

METHODS: This is a retrospective cohort study of a Canadian provincial perinatal HIV database from 1997 to 2015. Inclusion criteria were live birth and CART received for at least 4 weeks. Viral load rebound, defined as viral load greater than 50 copies/mL (or greater than 400 copies/mL for 1997–1998) and measured within 1 month before delivery, was identified in women who had at least one previous undetectable viral load during pregnancy. Logistic regressions were conducted to identify the risk factors for viral load rebound.

RESULTS: Among the 470 women in the database, 318 met inclusion criteria. Viral load rebound was experienced by 19 women (6.0%, 95% CI 3.7–9.3%) with a mean log10 viral load near delivery of 2.71 copies/mL (=513 copies/mL). Six (32%) had a viral load above 1,000 copies/mL. The rebound was detected within 1 day before delivery in 50% of the women. Aboriginal ethnicity, cocaine use, and hepatitis C virus polymerase chain reaction positivity were significantly associated with viral load rebound. There were no HIV vertical transmissions.

CONCLUSION: Even women attending for HIV care and achieving viral suppression in pregnancy can experience viral load rebound predelivery.

Even women attending for human immunodeficiency virus care and achieving viral suppression in pregnancy can experience viral load rebound within 1 month before delivery.

Departments of Obstetrics and Gynaecology and Medicine, University of British Columbia, the Women's Health Research Institute, BC Women's Hospital and Health Centre, and the British Columbia Centre for Excellence for HIV/AIDS, Vancouver, British Columbia, Canada.

Corresponding author: Deborah Money, MD, Department of Obstetrics and Gynaecology, University of British Columbia 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; email: deborah.money@ubc.ca

Isabelle Boucoiran was funded by a scholarship of the Sainte-Justine Foundation.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 40th Annual Scientific Meeting of the Infectious Diseases Society for Obstetrics and Gynecology, August 8–10, 2013, Santa Ana Pueblo, New Mexico.

The authors thank Zoe Lohn for her support with drafting the manuscript.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.