Journal Article

Predictive Factors of Plasma HIV Suppression during Pregnancy: A Prospective Cohort Study in Benin

Denoeud-Ndam, Lise, Azon-Kouanou, Angèle, Ogouyemi-Hounto, Aurore, Alao, Marouf J., Afangnihoun, Aldric, Azondékon, Alain, d'Almeida, Marcelline, Fourcade, Camille, Girard, Pierre-Marie, Zannou, Djimon-Marcel, Dossou-Gbété, Véronique, Cot, Michel

2013

Overview

To 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. Sub 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. HIV-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. Overall 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. This 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Analysis / Anti-HIV Agents - pharmacology / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiviral agents / Benin / Biological products industry / Cohort analysis / Cohort Studies / Disease transmission / Female / Health risk assessment / Highly active antiretroviral therapy / HIV / HIV (Viruses) / HIV Infections - blood / HIV Infections - transmission / HIV-1 - drug effects / HIV-1 - physiology / Human immunodeficiency virus / Humans / Infants / Infectious Disease Transmission, Vertical - prevention & control / Life Sciences / Logistic Models / Malaria / Malaria - prevention & control / Medical diagnosis / Medical research / Medicine / Medicine, Experimental / Minority & ethnic groups / Multivariate Analysis / Pregnancy / Pregnancy Complications - blood / Pregnancy Trimester, Third - blood / Pregnant women / Prevention / Prophylaxis / Prospective Studies / Regression analysis / Ribonucleic acid / RNA / RNA, Viral - blood / Santé publique et épidémiologie / Vector-borne diseases / Viral Load - drug effects / Womens health