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Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa.

Myer L, Phillips TK, Hsiao NY, Zerbe A, Petro G, Bekker LG, McIntyre JA, Abrams EJ - J Int AIDS Soc (2015)

Bottom Line: Among women on ART, 78% had VL<50 copies/mL and 13% had VL >1000 copies/mL at the time of their ANC visit.A large proportion of women entering ANC initiated ART before conception, and in this group more than 10% had VL>1000 copies/mL despite ART use.VL monitoring during pregnancy may help to identify pregnancies that require additional clinical attention to minimize MTCT risk and improve maternal and child health outcomes.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; landon.myer@uct.ac.za.

ABSTRACT

Introduction: Plasma HIV viral load (VL) is the principle determinant of mother-to-child HIV transmission (MTCT), yet there are few data on VL in populations of pregnant women in sub-Saharan Africa. We examined the distribution and determinants of VL in HIV-positive women seeking antenatal care (ANC) in Cape Town, South Africa.

Methods: Consecutive HIV-positive pregnant women making their first antenatal clinic visit were recruited into a cross-sectional study of viraemia in pregnancy, including a brief questionnaire and specimens for VL testing and CD4 cell enumeration.

Results & discussion: Overall 5551 pregnant women sought ANC during the study period, of whom 1839 (33%) were HIV positive and 1521 (85%) were included. Approximately two-thirds of HIV-positive women in the sample (n=947) were not on antiretrovirals at the time of the first ANC visit, and the remainder (38%, n=574) had initiated antiretroviral therapy (ART) prior to conception. For women not on ART, the median VL was 3.98 log10 copies/mL; in this group, the sensitivity of CD4 cell counts ≤350 cells/µL in detecting VL>10,000 copies/mL was 64% and this increased to 78% with a CD4 threshold of ≤500 cells/µL. Among women on ART, 78% had VL<50 copies/mL and 13% had VL >1000 copies/mL at the time of their ANC visit.

Conclusions: VL >10,000 copies/mL was commonly observed in women not on ART with CD4 cell counts >350 cells/µL, suggesting that CD4 cell counts may not be adequately sensitive in identifying women at greatest risk of MTCT. A large proportion of women entering ANC initiated ART before conception, and in this group more than 10% had VL>1000 copies/mL despite ART use. VL monitoring during pregnancy may help to identify pregnancies that require additional clinical attention to minimize MTCT risk and improve maternal and child health outcomes.

No MeSH data available.


Related in: MedlinePlus

Scatterplot of plasma HIV viral load versus nadir CD4 cell count, among HIV-positive pregnant women not using antiretrovirals. Vertical lines denote CD4 thresholds of 200, 350 and 500 cells/µL.
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Figure 0001: Scatterplot of plasma HIV viral load versus nadir CD4 cell count, among HIV-positive pregnant women not using antiretrovirals. Vertical lines denote CD4 thresholds of 200, 350 and 500 cells/µL.

Mentions: Figure 1 shows the distribution of CD4 and VL measures for women entering ANC not using antiretrovirals. VL of <50, 50–1000, 1001–10,000, 10,001–100,000 and >100,000 copies/mL were observed in 4, 12, 35, 38 and 10% of women not on ART, respectively. The sensitivity of CD4 cell counts ≤350 cells/µL in detecting VL>10,000 copies/mL was 64% (36% of women with VL>10,000 copies/mL had CD4>350 cells/µL; 95% CI: 32%–41%) and this increased to 78% with a CD4 threshold of ≤500 cells/µL. In the group of women with VL>10,000 copies/mL not on ART, younger age was associated with higher CD4 cell counts and a lower sensitivity of CD4 cell counts in detecting VL>10,000 copies/mL (p=0.002), but no other factors appeared to modify the association between CD4 cell count and VL (not shown).


Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa.

Myer L, Phillips TK, Hsiao NY, Zerbe A, Petro G, Bekker LG, McIntyre JA, Abrams EJ - J Int AIDS Soc (2015)

Scatterplot of plasma HIV viral load versus nadir CD4 cell count, among HIV-positive pregnant women not using antiretrovirals. Vertical lines denote CD4 thresholds of 200, 350 and 500 cells/µL.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495612&req=5

Figure 0001: Scatterplot of plasma HIV viral load versus nadir CD4 cell count, among HIV-positive pregnant women not using antiretrovirals. Vertical lines denote CD4 thresholds of 200, 350 and 500 cells/µL.
Mentions: Figure 1 shows the distribution of CD4 and VL measures for women entering ANC not using antiretrovirals. VL of <50, 50–1000, 1001–10,000, 10,001–100,000 and >100,000 copies/mL were observed in 4, 12, 35, 38 and 10% of women not on ART, respectively. The sensitivity of CD4 cell counts ≤350 cells/µL in detecting VL>10,000 copies/mL was 64% (36% of women with VL>10,000 copies/mL had CD4>350 cells/µL; 95% CI: 32%–41%) and this increased to 78% with a CD4 threshold of ≤500 cells/µL. In the group of women with VL>10,000 copies/mL not on ART, younger age was associated with higher CD4 cell counts and a lower sensitivity of CD4 cell counts in detecting VL>10,000 copies/mL (p=0.002), but no other factors appeared to modify the association between CD4 cell count and VL (not shown).

Bottom Line: Among women on ART, 78% had VL<50 copies/mL and 13% had VL >1000 copies/mL at the time of their ANC visit.A large proportion of women entering ANC initiated ART before conception, and in this group more than 10% had VL>1000 copies/mL despite ART use.VL monitoring during pregnancy may help to identify pregnancies that require additional clinical attention to minimize MTCT risk and improve maternal and child health outcomes.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa; landon.myer@uct.ac.za.

ABSTRACT

Introduction: Plasma HIV viral load (VL) is the principle determinant of mother-to-child HIV transmission (MTCT), yet there are few data on VL in populations of pregnant women in sub-Saharan Africa. We examined the distribution and determinants of VL in HIV-positive women seeking antenatal care (ANC) in Cape Town, South Africa.

Methods: Consecutive HIV-positive pregnant women making their first antenatal clinic visit were recruited into a cross-sectional study of viraemia in pregnancy, including a brief questionnaire and specimens for VL testing and CD4 cell enumeration.

Results & discussion: Overall 5551 pregnant women sought ANC during the study period, of whom 1839 (33%) were HIV positive and 1521 (85%) were included. Approximately two-thirds of HIV-positive women in the sample (n=947) were not on antiretrovirals at the time of the first ANC visit, and the remainder (38%, n=574) had initiated antiretroviral therapy (ART) prior to conception. For women not on ART, the median VL was 3.98 log10 copies/mL; in this group, the sensitivity of CD4 cell counts ≤350 cells/µL in detecting VL>10,000 copies/mL was 64% and this increased to 78% with a CD4 threshold of ≤500 cells/µL. Among women on ART, 78% had VL<50 copies/mL and 13% had VL >1000 copies/mL at the time of their ANC visit.

Conclusions: VL >10,000 copies/mL was commonly observed in women not on ART with CD4 cell counts >350 cells/µL, suggesting that CD4 cell counts may not be adequately sensitive in identifying women at greatest risk of MTCT. A large proportion of women entering ANC initiated ART before conception, and in this group more than 10% had VL>1000 copies/mL despite ART use. VL monitoring during pregnancy may help to identify pregnancies that require additional clinical attention to minimize MTCT risk and improve maternal and child health outcomes.

No MeSH data available.


Related in: MedlinePlus