HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods

Lynn T. Matthews, Heather B. Ribaudo, Angela Kaida, Kara Bennett, Nicholas Musinguzi, Mark J. Siedner, Jerome Kabakyenga, Peter W. Hunt, Jeffrey N. Martin, Yap Boum, Jessica E. Haberer, David Bangsberg

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. Methods: We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with $1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, <80% average adherence based on electronic pill caps (medication event monitoring system), and likelihood of 72-hour medication gaps across each period. Results: One hundred eleven women contributed 486 person-years of follow-up. Viral suppression was present at 89% of nonpregnancy, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%- 98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence,80% was less likely during periconception (adjusted odds ratio, 0.68), and 72-hour gaps per 90 days were less frequent during periconception (adjusted relative risk, 0.72) and more frequent during postpartum (adjusted relative risk, 1.40). Conclusions: Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

Original languageEnglish (US)
Pages (from-to)399-406
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume71
Issue number4
DOIs
StatePublished - 2016
Externally publishedYes

Fingerprint

Postpartum Period
HIV-1
HIV
RNA
Pregnancy
Therapeutics
Odds Ratio
Uganda
Medication Adherence
Pregnancy Outcome
Breast Feeding
Cohort Studies
Parturition
Prospective Studies

Keywords

  • Antiretroviral adherence
  • HIV-1
  • Periconception
  • Postpartum
  • Pregnancy
  • Uganda

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Medicine(all)

Cite this

HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods. / Matthews, Lynn T.; Ribaudo, Heather B.; Kaida, Angela; Bennett, Kara; Musinguzi, Nicholas; Siedner, Mark J.; Kabakyenga, Jerome; Hunt, Peter W.; Martin, Jeffrey N.; Boum, Yap; Haberer, Jessica E.; Bangsberg, David.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 71, No. 4, 2016, p. 399-406.

Research output: Contribution to journalArticle

Matthews, LT, Ribaudo, HB, Kaida, A, Bennett, K, Musinguzi, N, Siedner, MJ, Kabakyenga, J, Hunt, PW, Martin, JN, Boum, Y, Haberer, JE & Bangsberg, D 2016, 'HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods', Journal of Acquired Immune Deficiency Syndromes, vol. 71, no. 4, pp. 399-406. https://doi.org/10.1097/QAI.0000000000000874
Matthews, Lynn T. ; Ribaudo, Heather B. ; Kaida, Angela ; Bennett, Kara ; Musinguzi, Nicholas ; Siedner, Mark J. ; Kabakyenga, Jerome ; Hunt, Peter W. ; Martin, Jeffrey N. ; Boum, Yap ; Haberer, Jessica E. ; Bangsberg, David. / HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 71, No. 4. pp. 399-406.
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abstract = "Background: HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. Methods: We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with $1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, <80{\%} average adherence based on electronic pill caps (medication event monitoring system), and likelihood of 72-hour medication gaps across each period. Results: One hundred eleven women contributed 486 person-years of follow-up. Viral suppression was present at 89{\%} of nonpregnancy, 97{\%} of periconception, 93{\%} of pregnancy, and 89{\%} of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90{\%} [interquartile range (IQR), 70{\%}-98{\%}], 93{\%} (IQR, 82{\%}- 98{\%}), 92{\%} (IQR, 72{\%}-98{\%}), and 88{\%} (IQR, 63{\%}-97{\%}) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence,80{\%} was less likely during periconception (adjusted odds ratio, 0.68), and 72-hour gaps per 90 days were less frequent during periconception (adjusted relative risk, 0.72) and more frequent during postpartum (adjusted relative risk, 1.40). Conclusions: Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.",
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T1 - HIV-infected ugandan women on antiretroviral therapy maintain HIV-1 RNA suppression across periconception, pregnancy, and postpartum periods

AU - Matthews, Lynn T.

AU - Ribaudo, Heather B.

AU - Kaida, Angela

AU - Bennett, Kara

AU - Musinguzi, Nicholas

AU - Siedner, Mark J.

AU - Kabakyenga, Jerome

AU - Hunt, Peter W.

AU - Martin, Jeffrey N.

AU - Boum, Yap

AU - Haberer, Jessica E.

AU - Bangsberg, David

PY - 2016

Y1 - 2016

N2 - Background: HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. Methods: We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with $1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, <80% average adherence based on electronic pill caps (medication event monitoring system), and likelihood of 72-hour medication gaps across each period. Results: One hundred eleven women contributed 486 person-years of follow-up. Viral suppression was present at 89% of nonpregnancy, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%- 98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence,80% was less likely during periconception (adjusted odds ratio, 0.68), and 72-hour gaps per 90 days were less frequent during periconception (adjusted relative risk, 0.72) and more frequent during postpartum (adjusted relative risk, 1.40). Conclusions: Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

AB - Background: HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. Methods: We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with $1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, <80% average adherence based on electronic pill caps (medication event monitoring system), and likelihood of 72-hour medication gaps across each period. Results: One hundred eleven women contributed 486 person-years of follow-up. Viral suppression was present at 89% of nonpregnancy, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%- 98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence,80% was less likely during periconception (adjusted odds ratio, 0.68), and 72-hour gaps per 90 days were less frequent during periconception (adjusted relative risk, 0.72) and more frequent during postpartum (adjusted relative risk, 1.40). Conclusions: Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

KW - Antiretroviral adherence

KW - HIV-1

KW - Periconception

KW - Postpartum

KW - Pregnancy

KW - Uganda

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