Study: Women who started ART during pregnancy retained long-term HIV control

In a prospective study, the researchers sought to analyse the long-term virologic outcomes in women involved in vertical prophylaxis (prevention of transmission of HIV from parent to child during pregnancy and childbirth) of HIV.

The results were published in the scientific journal The Lancet.

Option B+ is an approach to the prevention of vertical transmission of HIV in which women diagnosed with HIV are offered immediate treatment (ART) regardless of their CD4 count. This approach carries benefits as well as risks. For example, there are concerns about long-term treatment outcomes in high-burden HIV settings.

Scientists enrolled 10,161 eligible participants. The average follow-up lasted from 37 to 53 months. The average age of the participants was 31 years.

From the available data:

• 1245 - at the time of inclusion in the program were in the third trimester of pregnancy
• 4901 - started ART at least one month prior to enrollment
• 3380 - had advanced stage of HIV

Overall, the viral suppression rate was 88.2% (range from 85.1% to 90.6%) after 36 months or longer after enrollment.

In a complete case analysis, including patients with missing data, the risk of virologic failure in women decreased over time:

• 0.87 12–23 months after enrollment
• 0.65 at 24–35 months
• 0.63 at ≥36 months

An increased risk of virologic failure was observed among women younger than 20; those who started ART in late pregnancy; and those with advanced stage HIV.

The high viral suppression rates, among women who began treatment with Option B+ and continued to receive HIV care, are persistent and may continue to increase for at least 53 months.

The researchers note that the results could be better if problems faced by teenage mothers are addressed, including problems with late detection and testing for HIV in antenatal care. As previously reported, in Russia, the risk of mother-to-child transmission was reduced to 1.2% in 2019.