HIV Viral Load Rebound at Delivery in Women on Art with Previously Suppressed Viral Loads During the Same Pregnancy

Abstract

Background HIV viral load (VL) non-suppression can lead to adverse pregnancy outcomes, including vertical transmission (VT). Therefore, it is crucial to achieve and maintain viral suppression during pregnancy. Objectives The objectives of this study were to investigate the prevalence of HIV VL rebound at delivery in women with previously suppressed VLs in the same pregnancy, and also evaluate adherence to the 2019 PMTCT guidelines on VL testing. Methods This was a retrospective record review of pregnant women living with HIV (PWLHIV) and on antiretroviral therapy (ART) who delivered at Chris Hani Baragwanath Academic Hospital during the period 01 January to 31 December 2021. Patient files were randomly selected and data on demographics, timing and history of HIV diagnosis and treatment, VL testing during pregnancy and delivery, and infant outcomes were extracted. Results A total of 362 PWLHIV were included in the study and the majority (85.5%) were diagnosed with HIV prior to the index pregnancy and almost all were on ART at the first antenatal visit. HIV VL rebound was diagnosed in 11 women (3.6%), and of these, nine (82%) had a VL VIII between 50 and 1000 copies per ml, and two (18%) had a VL >1000 copies per ml. Overall, 56 (15.5%) women had no VLs done at delivery. Age was the only variable significantly associated with VL rebound at the time of delivery. No cases of VT were identified. Conclusion The low rate of HIV VL rebound at delivery is reassuring. While there was evidence of adherence to PMTCT guidelines in terms of ART initiation and monitoring, there are still gaps with regards to VL monitoring.