Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study. The Lancet Regional Health – Europe
Paioni et al. assessed the postnatal retention in care, viral suppression and infant follow-up among pregnant women living with HIV (WLWH) in the Swiss Mother and Child HIV Cohort Study (MoCHiV).
For the study, the authors included all pregnant WLWH in the “optimal scenario” (being under regular clinical care during pregnancy, and having stable HIV suppression, confirmed within the last four weeks prior to delivery) between January 2000 and December 2018. Women were assumed to be engaged in postpartum care if they had ≥1 HIV RNA measurement within the first 90 days, and to be retained in care if they had ≥1 HIV RNA measurement within 180 days of the postpartum period. Rates of viral suppression were assessed at 90 and 180 days after delivery. Correct infant follow-up was defined as having at least 1 HIV RNA measurement within the first 6 months, and a negative antibody serology test at 18-24 months.
The study included 737 deliveries in 586 mothers who were in the optimal scenario (median age at delivery 33 years, 56.4% were of African origin, median CD4 cell count 512 cells/μL). The rate of HIV care engagement was 81.8% (603/737), and 94.2% (694/737) were retained in care within 180 days, with start of antiretroviral therapy during the third trimester being the most important risk factor for failure of retention in care (OR 3.9, 95% CI 1.5-10.2). HIV suppression rates were 98% both at 90 and 180 days postpartum, and 26 women experienced viral failure, with illicit drug use being the most important risk factor (HR 13.2, 95% CI 2.3-73.6). Among the 553 infants with complete follow-up, 97% had an HIV-RNA performed within the first 6 months, and 69% had definitive exclusion of transmission with a serologic test no later than 24 months after delivery. Infants from mothers who delivered prior to 2005, and from mothers who experienced depression in the postpartum period were less likely to have a correct infant follow-up.
In summary, the present study shows high rates of retention in care and maternal HIV viral suppression among WLWH in the postpartum period. However, the authors identified clear risk factors for peri- and postpartal outcomes, including late start of antiretroviral therapy, illicit drug use and depression. These modifiable aspects should be addressed in the clinical care of pregnant WLWH, and considered when discussing the possibility of breastfeeding the newborn child.