Profile of birth outcomes, antiretroviral-adherence, and virologic control near delivery in a cohort of naïve and experienced pregnant people living with HIV in a PMTCT Center

This study investigated virologic suppression and antiretroviral therapy (ART) adherence in pregnant people living with HIV (PLWH) at a Prevention of Mother-to-Child Transmission (PMTCT) unit. The objective was to assess how prior ART experience impacts virologic suppression during pregnancy. A total of 350 pregnant PLWH were included and divided into three groups: ART-naïve, ART-experienced who conceived while on continuous ART, and ART-experienced who restarted ART during pregnancy. Virologic load (VL) was measured at entry, quarterly, and near delivery, with a primary endpoint of undetectable HIV VL (<40cp/mL) near delivery. Genotype tests were conducted for those with VL > 500 cp/mL at entry. Adherence was measured by ART pickup rates at the pharmacy. Results showed 89% achieved virologic suppression near delivery. Suppression rates were 93% in ART-naïve, 96% in those on continuous ART, and 60% in those who restarted ART. Resistance rates varied, with 24% for NNRTI and 0% for INSTI. Median ART pickup rates were highest in ART-naïve (100%) and lowest in those who restarted ART (71%). No vertical transmission occurred, but two stillbirths were reported. While overall virologic control was good, challenges remain for ART-experienced PLWH restarting ART during pregnancy.