Predictors of Viremia in Postpartum Women on Antiretroviral Therapy

PROMISE 1077HS Team

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)72-80
Number of pages9
JournalJournal of acquired immune deficiency syndromes (1999)
Volume83
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Viremia
Postpartum Period
Therapeutics
CD4 Lymphocyte Count
Viral Load
T-Lymphocytes
Pregnancy
HIV

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Predictors of Viremia in Postpartum Women on Antiretroviral Therapy. / PROMISE 1077HS Team.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 83, No. 1, 01.01.2020, p. 72-80.

Research output: Contribution to journalArticle

@article{4c3e2e21362248d6bdd559eab61e777b,
title = "Predictors of Viremia in Postpartum Women on Antiretroviral Therapy",
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.",
author = "{PROMISE 1077HS Team} and Hoffman, {Risa M.} and Warshaw, {Meredith G.} and Amico, {K. Rivet} and Jose Pilotto and Gaerolwe Masheto and Jullapong Achalapong and Elizabeth Machado and Kulkanya Chokephaibulkit and Geraldo Duarte and Esau Jo{\~a}o and Graham, {Kathleen K.} and Knapp, {Katherine M.} and Stek, {Alice M.} and Scott, {Gwendolyn B.} and Anne Coletti and Loftis, {Amy J.} and Nahida Chakhtoura and Currier, {Judith S.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1097/QAI.0000000000002228",
language = "English (US)",
volume = "83",
pages = "72--80",
journal = "Journal of acquired immune deficiency syndromes (1999)",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "1",

}

TY - JOUR

T1 - Predictors of Viremia in Postpartum Women on Antiretroviral Therapy

AU - PROMISE 1077HS Team

AU - Hoffman, Risa M.

AU - Warshaw, Meredith G.

AU - Amico, K. Rivet

AU - Pilotto, Jose

AU - Masheto, Gaerolwe

AU - Achalapong, Jullapong

AU - Machado, Elizabeth

AU - Chokephaibulkit, Kulkanya

AU - Duarte, Geraldo

AU - João, Esau

AU - Graham, Kathleen K.

AU - Knapp, Katherine M.

AU - Stek, Alice M.

AU - Scott, Gwendolyn B.

AU - Coletti, Anne

AU - Loftis, Amy J.

AU - Chakhtoura, Nahida

AU - Currier, Judith S.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85076196826&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076196826&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000002228

DO - 10.1097/QAI.0000000000002228

M3 - Article

C2 - 31651545

AN - SCOPUS:85076196826

VL - 83

SP - 72

EP - 80

JO - Journal of acquired immune deficiency syndromes (1999)

JF - Journal of acquired immune deficiency syndromes (1999)

SN - 1525-4135

IS - 1

ER -