Abstract
ObjectiveTo investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin.DesignSub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT.MethodsHIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy.ResultsOverall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression.ConclusionsThis study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.
Highlights
Despite the fact that in Sub-Saharan Africa, mother-to-child transmission (MTCT) of HIV has substantially decreased over the last decade, it continues to contribute to the disease’s burden in many countries
This study provides more evidence that antiretroviral therapy (ART) has to be initiated before the last trimester of pregnancy to achieve an undetectable plasma viral load (pVL) before delivery
Our study focused on HIV virologic suppression at the end of pregnancy, but we had some data about infants’ follow-up available from the Beninese national program for prevention of mother-to-child transmission (PMTCT)
Summary
Despite the fact that in Sub-Saharan Africa, mother-to-child transmission (MTCT) of HIV has substantially decreased over the last decade, it continues to contribute to the disease’s burden in many countries. It has been estimated that approximately 300 000 infants have been infected in Africa in 2011 [1] and more than half of them were expected to die before the age of two [2]. The natural MTCT rate without any intervention has been estimated between 30% and 45% depending on breastfeeding [3], and such transmission can occur at various periods including pregnancy (9%), delivery (16%) and post-partum, via breastfeeding (5%) [4]. One of the main objectives for HIV prevention and control as pointed out by the UNAIDS is the ‘‘virtual elimination of MTCT’’, which is planned to be achieved by 2015 [1]. The key element is that all HIV-infected women should receive an antiretroviral therapy (ART), started at least from 14 weeks of gestation, and continued until the end of the breastfeeding period.
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