Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding

During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART), despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting...

Primary HIV-1 infection carries a high risk of maternal-to-child HIV-1 transmission (MTCT) when occurring during pregnancy or breastfeeding [1, 2]. HIV-1 acquisition during pregnancy is often not identified because of limited repeat HIV-1 testing, although high HIV-1 incidence during this period has been observed [2, 3, 4]. Initiation of antiretroviral therapy (ART) reduces the risk of MTCT; however, few countries have policies which specifically address primary HIV-1 infection during pregnancy or breastfeeding or prioritize treatment in this situation. Women with primary HIV-1 infection are likely to have higher CD4 counts and thus not qualify for combination ART under many national guidelines for routine ART initiation, or may not be prioritized for urgent initiation where policies for universal treatment during pregnancy (Option B/B+) have been adopted.

Randomized clinical trials of novel HIV-1 prevention strategies frequently enroll reproductive-age women at high HIV-1 risk, who may also become pregnant during study follow-up. Frequent, scheduled HIV-1 testing presents an opportunity to identify HIV-1 acquisition, potentially permitting initiation of combination ART to reduce the risk of MTCT. However, HIV-1 prevention trial sites do not typically provide direct HIV-1 care, instead referring HIV-1 seroconverters to local institutions.

Full article at: http://goo.gl/QIneEb

By: 

Susan Morrison, Grace John-Stewart, Elizabeth A. Bukusi, Connie Celum, Jared M. Baeten

Department of Global Health, University of Washington, Seattle, WA, United States of America

Grace John-Stewart, Connie Celum, Jared M. Baeten

Department of Medicine, University of Washington, Seattle, WA United States of America

Grace John-Stewart, Connie Celum, Jared M. Baeten

Department of Epidemiology, University of Washington, Seattle, United States of America

John J. Egessa, Sylvia Kusemererwa, Jonathan Wangisi

The AIDS Support Organization, Kampala, Uganda

Sezi Mubezi, Nulu Bulya

Infectious Disease Institute, Makerere University, Kampala, Uganda

Dennis K. Bii, Elizabeth A. Bukusi

Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya

Francis Mugume

Kabwohe Clinical Research Center, Kabwohe, Uganda

James D. Campbell

Centers for Disease Control and Prevention, Entebbe, Uganda

  

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