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Impact of HIV-status disclosure on HIV viral load in pregnant and postpartum women on antiretroviral therapy

Brittain, Kirsty1,2; Mellins, Claude A.3; Remien, Robert H.3; Phillips, Tamsin K.1,2; Zerbe, Allison4; Abrams, Elaine J.4,5; Myer, Landon1,2

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 29, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002036
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Background: HIV-status disclosure is widely encouraged by counselling services, in part because it is thought to improve antiretroviral therapy (ART) adherence and thus HIV viral suppression. However, few longitudinal studies have examined the impact of disclosure on HIV viral load (VL) during pregnancy and postpartum.

Methods: We explored these associations among 1187 women living with HIV, enrolled between March 2013 and June 2014 in Cape Town, South Africa.

Results: Among women who tested HIV-positive before pregnancy, we observed no association between disclosure and VL at entry into antenatal care among those already on ART, nor at delivery and 12 months postpartum among those initiating ART. Among women who tested HIV-positive during pregnancy and initiated ART subsequently, disclosure to a male partner was associated with a reduced risk of VL ≥50 copies/mL at delivery [adjusted risk ratio (aRR): 0.56; 95% confidence interval (CI): 0.31-1.01]. After stratification by relationship status, this association was only observed among women who were married and/or cohabiting. In addition, disclosure to ≥1 family/community member was associated with a reduced risk of VL ≥50 copies/mL at 12 months postpartum (aRR: 0.69; 95% CI: 0.48-0.97) among newly-diagnosed women.

Conclusion: These findings suggest that the impact of disclosure on VL is modified by three factors: (i) timing of HIV diagnosis (before versus during the pregnancy); (ii) relationship to the person(s) to whom women disclose; and (iii) in the case of disclosure to a male partner, relationship status. Counselling about disclosure may be most effective if tailored to individual women’s circumstances.

1Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa

2Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa

3HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA

4ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA

5Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA

Correspondence: Kirsty Brittain, Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, Falmouth Building, University of Cape Town Faculty of Health Sciences, Anzio Road, Observatory, Cape Town, South Africa, 7925; Tel: +27 21 406 6747; Email: kirsty.brittain@uct.ac.za

Conflicts of interest and source of funding: No conflicts of interest declared. This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), grant number 1R01HD074558. Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation. Ms. Brittain is supported by the South African Medical Research Council under the National Health Scholars Programme. Drs. Mellins and Remien are supported by a grant from the National Institute of Mental Health (NIMH) to the HIV Center for Clinical and Behavioral Studies (P30-MH45320).

Meetings at which data were presented: Parts of these data were presented as a poster presentation at the 11th International Conference on HIV Treatment and Prevention Adherence, May 9-11, 2016, Fort Lauderdale.

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