Impact of Unchanged ART Dosage at Delivery in Women With Well-Controlled HIV During the Second Trimester

Background: French guidelines recommend a combination antiretroviral therapy (ART) consisting of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI) with a PI booster during pregnancy. Due to a decrease in plasma concentrations during the third trimester, an increase in the PI booster to 2 doses per day is recommended. However, this increase may not be necessary to maintain viral load control at delivery. The objective of this study is to assess the impact on the delivery of viral load (VL) of maintaining antiretroviral therapy (ART) dosage in patients with well-controlled HIV at the end of the second trimester. Methods: A retrospective, single-center, observational study was conducted between January 1, 2018, and December 31, 2023. Pregnant patients with HIV managed at our center, who received the recommended combination ART and had undetectable VL at 28 weeks’ gestation, were included. The primary outcome is the proportion with undetectable VL (<50 copies/mL) at delivery. Secondary outcomes were VL re-escalation in the third trimester, treatment at delivery, use of anti-integrases and need for intrapartum infusion of zidovudine. Results: One hundred fifteen pregnancies were included. The proportion of patients with undetectable VL at delivery was 93%. The rate of VL rebound during the third trimester was 13.9%, with only 7% of patients having VL >50 copies/mL at delivery. Conclusions: The absence of a systematic increase in ART dosage does not appear to negatively impact VL at delivery.