Viral suppression toward the end of one pregnancy does not necessarily carry over into the next pregnancy, an analysis of data on 736 U.S. women published in Journal of Acquired Immune Deficiency Syndromes showed.
The women all participated in the SMARTT study of pediatric HIV between 2007 and 2018; each had at least two live-born children during that time span. Around the delivery of their first pregnancy during the study period, more than 80% of participants were virally suppressed. By early in their next pregnancy, that proportion was down to just over 50%.
Post-partum challenges to remaining in care and adherent to treatment include balancing infant care and work, transportation issues and stigma, the authors noted. “Using a family-centered care model may optimize continuous care engagement and sustained viral suppression,” they suggested.
Another challenge may have been caring for a preterm infant. Overall, 14% of first or second pregnancies delivered prior to full term. That rate rose to 21% for third pregnancies, possibly because women were older at that point or had other medical conditions.
Participants who started protease inhibitors (PIs) or integrase strand transfer inhibitors (INSTIs) during their first trimester had greater odds of preterm births than those without the respective antiretroviral regimen (adjusted odds ratio for PIs: 1.97, INSTIs: 2.39). The model did not include other risk factors, such as preeclampsia, and relatively few women were on INSTIs, study authors cautioned.
The researchers called for further exploration of the potential association between INSTIs and preterm births to more fully inform treatment guidelines.