Page 388 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

HIV viraemia during pregnancy in women

receiving preconception antiretroviral therapy

in KwaDukuza, KwaZulu-Natal

Authors: Background: Preconception antiretroviral therapy (PCART) followed by sustained viral
Vuyokazi Ntlantsana 1 suppression is effective in preventing mother-to-child transmission of HIV. The rates of persistent
Richard J. Hift 2
Wendy P. Mphatswe 1 and transient viraemia in such patients have not been prospectively assessed in South Africa.
Objectives: We determined the prevalence of transient and persistent viraemia in HIV-positive
Affiliations:
1 Department of Obstetrics women entering antenatal care on PCART and studied variables associated with viraemia.
and Gynaecology, School of
Clinical Medicine, University Methods: We performed a prospective cross-sectional observational study of HIV-positive
of KwaZulu-Natal, Durban, pregnant women presenting to a primary healthcare facility in KwaZulu-Natal. All had
South Africa received at least 6 months of first-line PCART. Viral load (VL) was measured, patients were
interviewed, adherence estimated using a visual analogue scale and adherence counselling
2 School of Clinical Medicine, provided. Viral load was repeated after 4 weeks where baseline VL exceeded 50 copies/mL.
University of KwaZulu-Natal,
Durban, South Africa Results: We enrolled 82 participants. Of them, 59 (72%) pregnancies were unplanned. Fifteen

Corresponding author: participants (18.3%) were viraemic at presentation with VL > 50 copies/mL. Of these, seven
Vuyokazi Ntlantsana, (8.5%) had viral suppression (VL < 50 copies/mL), and eight remained viraemic at the second
Ntlantsanav@ukzn.ac.za visit. Adherence correlated significantly with viraemia at baseline. Level of knowledge
correlated with adherence but not with lack of viral suppression at baseline. Socio-economic
Dates:
Received: 05 Mar. 2018 indicators did not correlate with viraemia. No instances of vertical transmission were observed
Accepted: 05 Feb. 2019 at birth.
Published: 10 Apr. 2019
Conclusions: Approximately 20% of women receiving PCART may demonstrate viraemia.
How to cite this article: Half of these may be transient. Poor adherence is associated with viraemia, and efforts to
Ntlantsana V, Hift RJ, encourage and monitor adherence are essential. The rate of unplanned pregnancies is high,
Mphatswe WP. HIV viraemia and antiretroviral therapy programmes should focus on family planning needs of women in
during pregnancy in women
receiving preconception the reproductive age group to prevent viral non-suppression prior to pregnancy.
antiretroviral therapy in
KwaDukuza, KwaZulu-Natal. Keywords: Preconception Antiretroviral Therapy; HIV; Viraemia; Antenatal Care; Adherence.
S Afr J HIV Med. 2019;20(1),
a847. https://doi.org/
10.4102/sajhivmed.v20i1.847 Introduction

Copyright: Approximately 35 million people in the world are infected with HIV. Sub-Saharan Africa accounts
© 2019. The Authors. for 71% of these infections. Women account for 51% of the world’s HIV infections, and 90% of
1
2
Licensee: AOSIS. This work
is licensed under the HIV infections in children below 15 years of age are a result of mother-to-child transmission
3
Creative Commons (MTCT). The HIV prevalence among South African women attending antenatal clinics (ANCs) in
Attribution License. 2013 was reported as 29.9% in South Africa and as 37.4% in the province of KwaZulu-Natal.
4
Maternal viral load (VL) is one of the main determinants of MTCT. Studying the magnitude of
5
the problem of viraemia in pregnancy and identifying factors associated with this viraemia is
important if future generations are to be born HIV-free.
VL monitoring is the best means of predicting clinical outcomes and of measuring the effectiveness
of antiretroviral therapy (ART) programmes. Patients who respond successfully to ART will
6
normally demonstrate undetectable VLs. In some cases, virus may, however, be detectable during
therapy. We define low-level viraemia (LLV) as detectible viraemia above 50 copies/mL and
below 1000 copies/mL, as defined by Hermans et al. Low-level viraemia suggests ongoing HIV
7
7
replication and is associated with increased risk of eventual virological failure. Drug resistance
8
Read online: and non-adherence are important causes of persistent viraemia in patients receiving ART. Drug
Read online:
Scan this QR
Scan this QR resistance and, therefore, persistent viraemia is associated with previous exposure to ART or to
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code with your
smart phone or
smart phone or antiretroviral drugs given as part of prevention of MTCT (PMTCT) programmes, particularly
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mobile device where the patients were exposed to less-effective regimens, long-term exposure to ART and
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to read online.
primary infection with resistant strains of virus. 9
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