Jinga Nelly, Technau Karl-Günter, Clouse Kate, Ngcobo Nkosinathi, Nattey Cornelius, Hwang Candice, Grimsrud Anna, Wise Amy, van Dongen Nicola, Ferreira Thalia, Mudau Maanda, Maskew Mhairi
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand.
Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
medRxiv. 2025 Mar 20:2025.03.19.25324178. doi: 10.1101/2025.03.19.25324178.
Repeated monitoring of viral load (VL) among pregnant women living with HIV (WLWH) is critical in vertical transmission prevention. For women who are newly diagnosed with HIV during pregnancy, a subsequent VL is recommended three months after ART initiation, and for all women living with HIV, follow-up VL is required every six months throughout pregnancy and breastfeeding [2]. Here, we describe the uptake and timing of VL testing and frequency and distribution of viraemic episodes during pregnancy.
We linked prospective cohort data from WLWH whose infants were born at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg, South Africa (2013-2018) to laboratory data from the National Health Laboratory Services national HIV cohort. We report the uptake and timing of VL testing, and frequency of viremia and viral suppression. We also explore factors associated with having at least one or more VL test.
Data from 4,064 women with known dates of entry into antenatal care and delivery during the study period were analysed. Overall, less than half (46%) completed VL testing during pregnancy. Most VL were conducted during the third trimester (67%). Only 5% (n=100) were during the first trimester and 11% within 7 days of delivery. Three-quarters of tests during pregnancy indicated viral suppression (VL <400 copies/mL), 7% viraemic (VL 400-1000 copies/mL), and 19% high grade viraemia (VL >1000 copies/mL). We found that being older (≥35) and being engaged in HIV care prior to pregnancy were significantly associated with VL testing during pregnancy.
With less than half of pregnant women living with HIV in this study having a VL measure during their pregnancy, and VL testing occurring late in pregnancy, this study highlights critical gaps in providing quality HIV care to women and prevention of vertical transmission.
对感染艾滋病毒的孕妇（WLWH）进行病毒载量（VL）的重复监测对于预防垂直传播至关重要。对于孕期新诊断出感染艾滋病毒的女性，建议在开始抗逆转录病毒治疗（ART）三个月后进行后续病毒载量检测，对于所有感染艾滋病毒的女性，在整个孕期和哺乳期需要每六个月进行一次病毒载量随访检测[2]。在此，我们描述了孕期病毒载量检测的接受情况和时间安排，以及病毒血症发作的频率和分布情况。
我们将南非约翰内斯堡拉希玛·穆萨母婴医院（RMMCH）出生婴儿的感染艾滋病毒孕妇（2013 - 2018年）的前瞻性队列数据与国家卫生实验室服务机构国家艾滋病毒队列的实验室数据相链接。我们报告病毒载量检测的接受情况和时间安排，以及病毒血症和病毒抑制的频率。我们还探讨了与进行至少一次或多次病毒载量检测相关的因素。
分析了研究期间4064名已知产前护理和分娩日期的女性的数据。总体而言，不到一半（46%）的女性在孕期完成了病毒载量检测。大多数病毒载量检测在孕晚期进行（67%）。仅5%（n = 100）在孕早期进行，11%在分娩后7天内进行。孕期四分之三的检测显示病毒得到抑制（病毒载量<400拷贝/毫升），7%为病毒血症（病毒载量400 - 1000拷贝/毫升），19%为高等级病毒血症（病毒载量>1000拷贝/毫升）。我们发现年龄较大（≥35岁）以及在怀孕前接受艾滋病毒护理与孕期进行病毒载量检测显著相关。
本研究中不到一半的感染艾滋病毒孕妇在孕期进行了病毒载量检测，且病毒载量检测在孕期后期进行，这项研究凸显了在为女性提供优质艾滋病毒护理和预防垂直传播方面的关键差距。
