Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study.

Background: Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met.
Methods: We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models.
Findings: Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024).
Interpretation: Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries.
Funding: This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation.
Competing Interests: BMT received payments from Effik AG, and Pierre-Favre Pharma for her participation to advisory boards. The institution of EB received honoraria from Gilead Sciences, ViiV Healthcare, MSD, Pfizer AG, Ely Lilly, and Astra Zeneca for his participation to advisory boards, and travel grants from Gilead Sciences, ViiV Healthcare, MSD, and Pfizer AG. DLB received honoraria from Gilead Sciences, ViiV Healthcare, and Merck for his participation to advisory boards and for lectures, payments from Abbvie for lectures, and travel grants from Gilead Sciences. RK received research grants from Gilead Sciences, the Swiss National Science Foundation (SNSF) and the National Institutes of Health (NIH) unrelated to this work. CP received honoraria from Effik AG for his participation to advisory boards. The authors have no other conflicts of interest to disclose.
(© 2023 The Author(s).)