Prevalence of undetectable and suppressed viral load in HIV‑infected pregnant women initiating Option B+ in Uganda: an observational study nested within a randomized controlled trial
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Nature
Abstract
Viral load (VL) testing is key in monitoring adherence to antiretroviral therapy (ART) and documenting
HIV treatment response. As per HIV treatment guidelines in Uganda, the first VL test is recommended 6 months after
initiation of ART. Undetectable VL (uVL) at ART initiation may be helpful in detecting elite controllers in the absence of
previous ART use. We investigated viral suppression at ART initiation among a cohort of HIV-positive pregnant women
enrolled in the Friends for Life Circles (FLC) for Option B+ randomized controlled trial (RCT).
Methods: Pregnant women ≥ 18 years of age testing positive for HIV at their first antenatal care visit and starting on
ART Option B+ as per the National PMTCT Program guidelines were enrolled into the FLC for Option B+ RCT in urban
Kampala and rural Mityana districts of Uganda. Each participant had whole blood samples collected at enrolment to
assess baseline VL. Plasma HIV-1 RNA was quantified using COBAS Ampliprep /COBAS Taqman. Baseline VL below 400
RNA copies/ml was considered as viral suppression while baseline VL below 20 RNA copies/ml was considered uVL.
Results: The mean duration from the date of ART initiation to time of sample collection for baseline VL assessment
was 4.4 days (SD 3.6). Of the 532 HIV-positive pregnant women enrolled in the FLC for Option B+ study and newly
starting Option B+ without a self-reported history of prior ART use, 29 (5.5%) had uVL and 113 (21.4%) had suppressed
VL at baseline. There was no association between participants’ age, gravidity, marital status, mean monthly
income, educational level, disclosure of HIV status to partner, and uVL or viral suppression at baseline. However, nondisclosure
of HIV status to any other person was associated with decreased odds of viral suppression at baseline (OR
0.640; 0.416–0.982).
Conclusion: Twenty-one percent of HIV-positive Ugandan pregnant women initiating ART (Option B+) showed virological
suppression at baseline and were presumed to be “elite controllers” or to have misreported being ART-naive.
Description
Keywords
HIV, Pregnancy, Viral load, Viral or virological suppression, Uganda, HIV transmission, Option B+, , Antiretroviral therapy
Citation
Gabagaya, G., Rukundo, G., Amone, A., Wavamunno, P., Namale-Matovu, J., Lubega, I., ... & Musoke, P. (2021). Prevalence of undetectable and suppressed viral load in HIV-infected pregnant women initiating Option B+ in Uganda: an observational study nested within a randomized controlled trial. BMC infectious diseases, 21(1), 1-7.doi:10.1186/s12879-021-06608-4