Objective: The objective of this study is to assess the risk of viral rebound in postpartum women on suppressive combination antiretroviral therapy (cART). Methods: Using data from the UK Collaborative HIV Cohort (UK CHIC) study and the UK and Ireland National Study of HIV in Pregnancy and Childhood (NSHPC), women with HIV-RNA 50copies/ml or less at delivery in 2006-2011, who started life-long cART during pregnancy (n=321) or conceived on cART (n=618), were matched by age, duration on cART and time period, with at least one control (non-postpartum). The cumulative probability of viral rebound (HIV-RNA >200copies/ml) was assessed by Kaplan-Meier analysis; adjusted hazard ratios (aHRs) for the 0-3 and 3-12 months postdelivery (cases)/pseudo-delivery (controls) were calculated in Cox proportional hazards models. Results: In postpartum women who conceived on cART, 5.9% [95% confidence interval (95% CI) 4.0-7.7] experienced viral rebound by 3 months, and 2.2% (1.4-3.0%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during the first 3 months [aHR 2.63 (1.58-4.39)] but not during the 3-12 months postdelivery/pseudo-delivery. In postpartum women who started cART during pregnancy, 27% (22-32%) experienced viral rebound by 3 months, and 3.0% (1.6-4.4%) of their controls. The risk of viral rebound was higher in postpartum women than in controls during both postdelivery/pseudo-delivery periods [<3 months: aHR 6.63 (3.58-12.29); 3-12 months: aHR 4.05 (2.03-8.09)]. Conclusion: In women on suppressive cART, the risk of viral rebound is increased following delivery, especially in the first 3 months, which may be related to reduced adherence, indicating the need for additional adherence support for postpartum women.
Bibliographical noteFunding Information:
S.H. carried out the statistical analysis and drafted the manuscript. T.H. undertook data acquisition. All coauthors contributed to the interpretation and drafting of the manuscript. UK CHIC steering committee included: J. Ainsworth, S. Allan, J. Anderson, A. Babiker,D. Chadwick, V. Delpech, D. Dunn, M. Fisher, B. Gazzard (Chair), R. Gilson, M. Gompels, P. Hay, T. Hill, M. Johnson, S. Kegg, C. Leen, F. Martin, M. Nelson, C. Orkin, A. Palfreeman, A. Phillips, D. Pillay, F. Post, J. Pritchard, C. Sabin (PI), A. Schwenk, A. Tariq, R. Trevelion, J. Walsh. UK CHIC central co-ordination: Research Department of Infection & Population Health, UCL, London (T. Hill, S. Huntington, S. Jose, A. Phillips, C. Sabin, A. Thornton); Medical Research Council Clinical Trials Unit (MRC CTU), London (D. Dunn, A. Glabay). UK CHIC participating sites: Barts & The London NHS Trust, London (C. Orkin, J. Lynch, J. Hand, C. de Souza); Brighton and Sussex University Hospitals NHS Trust (M. Fisher, N. Perry, S. Tilbury, D. Churchill); Chelsea and Westminster NHS Trust, London (B. Gazzard, M. Nelson, M. Waxman, D. Asboe, S. Mandalia); Public Health England (PHE), Centre for Infections, London (V. Delpech); Homerton University Hospital NHS Trust, London (J. Anderson, S. Munshi, D. Awosika); King''s College Hospital, London (F. Post, H. Korat, C. Taylor, Z. Gleisner, F. Ibrahim, L. Campbell); UCL Medical School and The Mortimer Market Centre, London (R. Gilson, N. Brima, I.Williams); North Bristol NHS Trust (M. Gompels, S. Allen); North Middlesex University Hospital NHS Trust, London (A. Schwenk, J. Ainsworth, C. Wood, S. Miller); Royal Free NHS Trust & Department of Infection & Population Health, UCL, London (M. Johnson, M. Youle, F. Lampe, C. Smith, H. Grabowska, C. Chaloner, D. Puradiredja); Imperial College Healthcare NHS Trust, London (J. Walsh, N. Mackie, A. Winston, J.Weber, F. Ramzan); The Lothian University Hospitals NHS Trust, Edinburgh (C. Leen, A. Wilson); University of Leicester NHS Trust (A. Palfreeman, A. Moore, L. Fox); South Tees Hospitals NHS Foundation Trust (D. Chadwick, K. Baillie); Woolwich NHS Trust (S. Kegg, P. Main); Coventry &Warwickshire NHS Trust (S. Allan); St. George''s NHS Trust (P. Hay, M. Dhillon); York NHS Foundation Trust (F. Martin, S. Douglas); The Royal Wolverhampton NHS Trust (A. Tariq); Ashford and St Peter''s Hospital NHS Foundation Trust (J. Pritchard). NSHPC Steering Committee included: M. Cortina- Borja, A. Brown, A. de Ruiter, S. Donaghy, S. Farthing, K. Harding, A. Judd, L. Logan, H. Lyall, A. Namiba, F. Ncube, C. Peckham (chair), L. Primrose, C. Thorne, P. Tookey (PI), S. Webb. We gratefully acknowledge the contribution of the midwives, obstetricians, genitourinary physicians, paediatricians, clinical nurse specialists and all other colleagues who report to the NSHPC through the British Paediatric Surveillance Unit of the Royal College of Paediatrics and Child Health, and the obstetric reporting scheme run under the auspices of the Royal College of Obstetricians and Gynaecologists. Ethics approval for NSHPC was renewed following review by the London Multi-Centre Research Ethics Committee in 2004 (MREC/04/2/009). The UK CHIC is funded by the UK Medical Research Council (MRC) (Grant numbers G0000199, G0600337 and G0900274). The NSHPC receives core funding from PHE (grant number GHP/003/013/003). Data are collated at the UCL Institute of Child Health, which receives a proportion of funding from the Department of Health''s National Institute for Health Research Biomedical Research Centres funding scheme. S.H. has a UCL Studentship, funded by the MRC, for postgraduate work.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
- postpartum women
- pregnant women
- viral load