Viral Load Rebound Seen After HIV Suppression in Pregnancy

HealthDay News — Women achieving HIV viral suppression in pregnancy can experience viral load rebound predelivery, according to a study published in Obstetrics & Gynecology.1

Isabelle Boucoiran, MD, from the University of British Columbia in Vancouver, Canada, and colleagues used a Canadian provincial perinatal HIV database (1997 to 2015) to identify patients who had a live birth, received combination antiretroviral therapy for at least 4 weeks, had viral load measured within 1 month of delivery, and had at least 1 previous undetectable viral load during pregnancy. Viral load rebound was defined as viral load >50 copies/mL (or >400 copies/mL for 1997 to 1998).

The researchers found that 318 of the 470 women in the database met inclusion criteria. Nineteen women (6%) had viral load rebound with a mean log10 viral load near delivery of 2.71 copies/mL (=513 copies/mL), while 6 women (32%) had a viral load above 1,000 copies/mL.

In 50% of the women, rebound was detected within 1 day before delivery. Viral load rebound was significantly associated with aboriginal ethnicity, cocaine use, and hepatitis C virus polymerase chain reaction positivity. There were no HIV vertical transmissions.

“Even women attending for HIV care and achieving viral suppression in pregnancy can experience viral load rebound predelivery,” the authors write.

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Boucoiran I, Albert AYK, Tulloch K, et al. Human immunodeficiency virus viral load rebound near delivery in previously suppressed, combination antiretroviral therapy-treated pregnant women. Obstet Gynecol. 2017; 130(3): 497-501.