PMID- 32053679
OWN - NLM
STAT- MEDLINE
DCOM- 20200518
LR  - 20200518
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 15
IP  - 2
DP  - 2020
TI  - Time of HIV diagnosis, CD4 count and viral load at antenatal care start and 
      delivery in South Africa.
PG  - e0229111
LID - 10.1371/journal.pone.0229111 [doi]
LID - e0229111
AB  - BACKGROUND: Despite the success of prevention of mother to child transmission 
      (PMTCT) program in South Africa, the 30% HIV prevalence among women of 
      childbearing age requires the PMTCT program to be maximally efficient to sustain 
      gains in the prevention of vertical HIV transmission. We aimed to determine the 
      immunologic and virologic status at entry into antenatal care (ANC) and at 
      childbirth among HIV positive women who conceived under the CD4<500 cells/mul 
      antiretroviral therapy (ART) eligibility threshold and universal test and treat 
      (UTT) policies in the Gauteng province of South Africa. METHOD: We conducted a 
      retrospective cohort study of 692 HIV positive adult (>18 years) postpartum women 
      who gave birth between September 2016 and December 2017. Demographic, viral load 
      (VL) and CD4 data at ANC start (3-9 months before delivery) and delivery (3 
      months before/after) were obtained from medical records of consenting women. We 
      compared CD4>/=500 cell/mul and viral load (VL) suppression (<400 copes/ml) rates at 
      ANC start and delivery among women with a pre-pregnancy ART, women known HIV 
      positive but with in-pregnancy ART and newly diagnosed women with in-pregnancy 
      ART. Predictors of having a high CD4 and suppressed VL were assessed by 
      log-binomial regression. RESULTS: Of the 692 participants, 394 (57.0%) had CD4 
      data and 326 (47.1%) had VL data. Overall women with a pre-pregnancy ART were 
      more likely to start ANC with CD4 count>/=500 cell/mul (46.3% vs 24.8%, adjusted 
      risk ratio (aRR) = 1.9; 95% confidence interval (95% CI): 1.4-2.5), compared to 
      newly diagnosed women. This difference was no longer apparent at the time of 
      delivery (aRR 1.2 95% CI: 0.4-3.7). Similarly, viral suppression at delivery was 
      higher among women with pre-pregnancy ART (87.2% vs 69.3%, aRR 1.3, 95% CI: 
      1.1-1.6) as compared to the newly diagnosed women. Viral suppression rate among 
      newly diagnosed women increased substantially by the time of delivery from 43.5% 
      to 69.3% (p = 0.001). CONCLUSION: These results show that pre-pregnancy ART 
      improves immunologic and virologic control during pregnancy and call for renewed 
      efforts in HIV testing, linkage to ART and viral monitoring.
FAU - Onoya, Dorina
AU  - Onoya D
AUID- ORCID: 0000-0002-2664-7342
AD  - Health Economics and Epidemiology Research Office, Department of Internal 
      Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of 
      the Witwatersrand, Johannesburg, South Africa.
FAU - Nattey, Cornelius
AU  - Nattey C
AUID- ORCID: 0000-0002-8272-9529
AD  - Health Economics and Epidemiology Research Office, Department of Internal 
      Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of 
      the Witwatersrand, Johannesburg, South Africa.
FAU - Jinga, Nelly
AU  - Jinga N
AD  - Health Economics and Epidemiology Research Office, Department of Internal 
      Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of 
      the Witwatersrand, Johannesburg, South Africa.
FAU - Mongwenyana, Constance
AU  - Mongwenyana C
AD  - Health Economics and Epidemiology Research Office, Department of Internal 
      Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of 
      the Witwatersrand, Johannesburg, South Africa.
FAU - Sherman, Gayle
AU  - Sherman G
AD  - Department of Paediatrics and Child Health, Faculty of Health Sciences, 
      University of the Witwatersrand and National Institute for Communicable Diseases, 
      a division of the National Health Laboratory Service, Johannesburg, South Africa.
LA  - eng
GR  - PEPFAR/PEPFAR/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20200213
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - *CD4 Lymphocyte Count
MH  - HIV Infections/*prevention & control
MH  - Humans
MH  - Infectious Disease Transmission, Vertical/prevention & control
MH  - Prenatal Care/methods
MH  - Retrospective Studies
MH  - South Africa
MH  - Viral Load/*physiology
PMC - PMC7018033
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/02/14 06:00
MHDA- 2020/05/19 06:00
PMCR- 2020/02/13
CRDT- 2020/02/14 06:00
PHST- 2019/09/25 00:00 [received]
PHST- 2020/01/29 00:00 [accepted]
PHST- 2020/02/14 06:00 [entrez]
PHST- 2020/02/14 06:00 [pubmed]
PHST- 2020/05/19 06:00 [medline]
PHST- 2020/02/13 00:00 [pmc-release]
AID - PONE-D-19-25315 [pii]
AID - 10.1371/journal.pone.0229111 [doi]
PST - epublish
SO  - PLoS One. 2020 Feb 13;15(2):e0229111. doi: 10.1371/journal.pone.0229111. 
      eCollection 2020.