HIV Viral Rebound Can Occur in Pregnant Women on Combination ART

Women can experience HIV viral rebound right before giving birth, even if they achieved viral suppression, according to a recent study.

The retrospective cohort study included data from 318 women enrolled in the Canadian provincial perinatal HIV database from 1997 to 2015. Women included in the study had received antenatal combination antiretroviral therapy (CART) at least 4 weeks before giving birth. Viral load rebound was identified in women who had at least 1 previous undetectable viral load during pregnancy, and was measured within 1 month before delivery. In addition, researchers identified risk factors associated with HIV viral load rebound.
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Overall, 19 women (6%) experienced viral load rebound. The mean log10 viral load near delivery was 2.71 copies/mL, but 6 of the women had viral loads above 1000 copies/mL.

Viral rebound within 1 day of delivery was detected in 50% of the women. However, no HIV vertical transmissions occurred.

Risk factors associated with viral load rebound included cocaine use, hepatitis C virus polymerase chain reaction positivity, and aboriginal ethnicity.

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

—Melissa Weiss

Reference:

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 [published correct August 4, 2017]. Obstet Gynecol. doi:10.1097/AOG.0000000000002133.