Publication:
Predictors of Viremia in Postpartum Women on Antiretroviral Therapy

Issued Date

2020-01-01

Resource Type

Article

ISSN

19447884

DOI

10.1097/QAI.0000000000002228

Other identifier(s)

2-s2.0-85076196826

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of acquired immune deficiency syndromes (1999). Vol.83, No.1 (2020), 72-80

Suggested Citation

Risa M. Hoffman, Meredith G. Warshaw, K. Rivet Amico, Jose Pilotto, Gaerolwe Masheto, Jullapong Achalapong, Elizabeth Machado, Kulkanya Chokephaibulkit, Geraldo Duarte, Esau João, Kathleen K. Graham, Katherine M. Knapp, Alice M. Stek, Gwendolyn B. Scott, Anne Coletti, Amy J. Loftis, Nahida Chakhtoura, Judith S. Currier Predictors of Viremia in Postpartum Women on Antiretroviral Therapy. Journal of acquired immune deficiency syndromes (1999). Vol.83, No.1 (2020), 72-80. doi:10.1097/QAI.0000000000002228 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/49675

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Title

Predictors of Viremia in Postpartum Women on Antiretroviral Therapy

Author(s)

Risa M. Hoffman
 Meredith G. Warshaw
 K. Rivet Amico
 Jose Pilotto
 Gaerolwe Masheto
 Jullapong Achalapong
 Elizabeth Machado
 Kulkanya Chokephaibulkit
 Geraldo Duarte
 Esau João
 Kathleen K. Graham
 Katherine M. Knapp
 Alice M. Stek
 Gwendolyn B. Scott
 Anne Coletti
 Amy J. Loftis
 Nahida Chakhtoura
 Judith S. Currier

Other Contributor(s)

FHI 360
 Botswana Harvard AIDS Institute Partnership
 University of Southern California
 University of Miami
 Fundacao Oswaldo Cruz
 University of Michigan, Ann Arbor
 The University of North Carolina at Chapel Hill
 St. Jude Children's Research Hospital
 National Institute of Child Health and Human Development
 Faculty of Medicine, Siriraj Hospital, Mahidol University
 Universidade de Sao Paulo - USP
 Center for Biostatistics in AIDS Research
 David Geffen School of Medicine at UCLA
 Universidade Federal do Rio de Janeiro
 Hospital Federal dos Servidores do Estado
 Chiangrai Prachanukroh Hospital
 Children's Diagnostic and Treatment Center

Abstract

BACKGROUND: HIV-infected, postpartum women on antiretroviral therapy (ART) have high rates of viremia. We examined predictors of postpartum viremia in the PROMISE study. METHODS: Women with pre-ART CD4 T-cell counts ≥400 cells/mm who started ART during pregnancy were randomized postpartum to continue ART (CTART) or discontinue ART (DCART). Viral load and self-reported adherence were collected every 12 weeks, up to 144 weeks. Women in DCART reinitiated therapy when clinically indicated. Viremia was defined as 2 consecutive viral loads >1000 copies/mL after 24 weeks on ART. Adherence was dichotomized as missing versus not missing ART doses in the past 4 weeks. Predictors of viremia were examined using Cox proportional hazards regression with adherence as a time-varying covariate. RESULTS: Among 802 women in the CTART arm, median age at entry was 27 years and median CD4 T-cell count 696 cells/mm. Of 175 women in CTART with viremia (22%), 141 had resistance data, and 12% had resistance to their current regimen. There was an estimated 0.12 probability of viremia by week 48 and 0.25 by week 144. Predictors of viremia included missed ART doses within the past 4 weeks, younger age, shorter duration of pre-entry ART, and being from the South American/Caribbean region. Of 137 women in DCART who reinitiated therapy, probability of viremia was similar to CTART (0.24 by week 96; 0.27 by week 144). CONCLUSIONS: Rates of postpartum viremia are high and viremia is more likely in younger postpartum women who start ART later in pregnancy. Interventions should target these higher-risk women.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/49675

Collections

Scopus 2020