Latham Alexandra H, Lugo Morales Andrea, Barba Gutierrez Elizabeth, Jochum Michael, Conrad Sarah, Clark Eva H, Goytia Kassandra, Alam Megan, Gerard Jessica, McKinney Jennifer
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.
Department of Obstetrics and Gynecology, Harris Health System, Houston, TX, United States.
Front Med (Lausanne). 2025 Jun 27;12:1561490. doi: 10.3389/fmed.2025.1561490. eCollection 2025.
People living with HIV (PLWH) often experience low rates of retention in HIV care (RIC) and suboptimal viral suppression postpartum. Understanding contemporary barriers to RIC is crucial to identify risk factors for loss to care and thereby improve support during this vulnerable transition. This work aimed to identify factors associated with adequate RIC, defined as two HIV care visits ≥90 days apart in the first year postpartum.
Electronic records were retrospectively reviewed for PLWH who delivered from 2019 to 2023 and received prenatal care within a single county health system. Variables were collected related to both maternal and neonatal HIV and obstetric or pediatric care. Variables were analyzed using descriptive statistics, and Kaplan-Meier curves were used to assess viral suppression during pregnancy and the first year postpartum. A Random Forest machine learning model was used to determine variables of relative importance for prediction of adequate RIC. Multivariable logistic regression was used to evaluate impact of identified variables on RIC.
Of 182 pregnancies, sixty individuals (33%) achieved adequate postpartum RIC. Adequate RIC correlated with year of delivery ( = 0.018), attending at least two obstetrical postpartum visits ( = 0.025), viral suppression at initial prenatal visit ( = 0.030), and shorter duration between pregnancy visit and HIV care visits before and after pregnancy ( < 0.001). Viral suppression was generally excellent at time of delivery (99.4%). However, viral loads rebounded after delivery, with 66.8% suppressed at 12 months postpartum. Random Forest modeling identified several clinical and social factors with relative importance for prediction of RIC. Multivariable logistic regression supported above findings with significant decreased odds of adequate RIC based on year of delivery [2021 aOR 0.306 (0.097-0.956), 2022 0.146 (0.046-0.458), 2023 0.071 (0.011-0.455)], higher viral load at initial prenatal visit [aOR 0.038 (0.002-0.889)], and longer duration between last HIV care visit and first pregnancy visit [aOR 0.419 (0.176-0.998)].
Postpartum RIC was suboptimal in this contemporary US single-site cohort. Engagement in prenatal and postpartum obstetric care predicted improved postpartum RIC. Further qualitative research is essential to improve deeper understanding of patterns of engagement perinatally in order to develop effective interventions to improve support for individuals during this difficult transition.
感染人类免疫缺陷病毒（HIV）的人群（PLWH）在HIV治疗中的留存率（RIC）往往较低，产后病毒抑制效果也不理想。了解当前影响RIC的障碍对于识别失访风险因素至关重要，从而在这一脆弱的过渡阶段改善支持措施。这项研究旨在确定与充足的RIC相关的因素，充足的RIC定义为产后第一年有两次间隔≥90天的HIV治疗就诊。
对2019年至2023年在单一县卫生系统分娩并接受产前护理的PLWH的电子记录进行回顾性审查。收集了与孕产妇和新生儿HIV以及产科或儿科护理相关的变量。使用描述性统计分析变量，并使用Kaplan-Meier曲线评估孕期和产后第一年的病毒抑制情况。使用随机森林机器学习模型确定预测充足RIC的相对重要变量。使用多变量逻辑回归评估已识别变量对RIC的影响。
在182例妊娠中，60例（33%）实现了充足的产后RIC。充足的RIC与分娩年份（P = 0.018）、至少参加两次产科产后就诊（P = 0.025）、初次产前就诊时的病毒抑制情况（P = 0.030）以及孕期就诊与妊娠前后HIV治疗就诊之间的间隔时间较短（P < 0.001）相关。分娩时病毒抑制情况总体良好（99.4%）。然而，产后病毒载量反弹，产后12个月时66.8%的患者病毒得到抑制。随机森林建模确定了几个对预测RIC具有相对重要性的临床和社会因素。多变量逻辑回归支持上述发现，基于分娩年份，充足RIC的几率显著降低[2021年调整后比值比（aOR）0.306（0.097 - 0.956），2022年0.146（0.046 - 0.458），2023年0.071（0.011 - 0.455）]，初次产前就诊时病毒载量较高[aOR 0.038（0.002 - 0.889）]，以及最后一次HIV治疗就诊与首次妊娠就诊之间的间隔时间较长[aOR 0.419（0.176 - 0.998）]。
在这个当代美国单中心队列中，产后RIC不理想。参与产前和产后产科护理可预测产后RIC的改善。进一步的定性研究对于更深入了解围产期参与模式至关重要，以便制定有效的干预措施，在这一困难的过渡阶段改善对个体的支持。
