Journal of Acquired Immune Deficiency Syndrome, January 2020
Undetectable viral load is associated with optimal health outcomes for people living with HIV. However, among women living with HIV who have recently given birth and are on ART, there are high rates of viremia, which typically occurs because women are struggling to take their medication every day. 1077HS/4 sought to better understand the characteristics of post-partum women with viremia in order to understand how best to support their adherence.
The study enrolled a subset of women who were part of the PROMISE study. PROMISE was originally designed during the era when women living with HIV were instructed to take ART during pregnancy and then stop after delivery if they had strong immune systems. PROMISE enrolled postpartum women with good immune function (CD4 counts > 400 cells/mm3) from 56 sites in Argentina, Botswana, Brazil, China, Haiti, Peru, Thailand, and the U.S. between December 2011 and November 2014. Women were randomly assigned to continue their ART (828 women) or discontinue it (825 women) under their providers’ supervision. When deemed medically necessary, women who discontinued treatment were put back on ART. 1077HS/4 looked at a subset of PROMISE women who were on ART during study follow-up: those in the group asked to continue ART (802 women) and those who discontinued ART but later restarted for a medical reason (137 women). Over 144 weeks of follow-up, researchers evaluated the frequency with which women experienced viremia (>1000 copies/mL), their ART adherence (self-reported missed doses), and their self-reported health.
The study found that viremia was common among all women who had recently given birth who were continuing on ART (~20%) and that most viremia was due to difficulty taking medication rather than drug resistance (only 12% had viremia due to resistance). Younger women, women who started ART later in pregnancy, and women enrolled from the South American/Caribbean region had the highest rates of viremia during follow-up. Women in the group who discontinued ART and restarted later had very similar rates of viremia compared to women who continued ART after delivery. Among women with viremia, many never returned to an undetectable viral load during the follow-up period. Information from this study and others like it can be used to design programs to support the adherence of post-partum women on ART and tailor these adherence interventions to women’s unique needs.