Option B+ Antiviral Regimen Helps Mothers Achieve HIV Suppression

By Lisa Rapaport

March 01, 2021

(Reuters Health) - Antiretroviral therapy (ART) initiated during pregnancy and continued postpartum to help prevent maternal-child transmission of HIV may also help mothers sustain long-term viral suppression, a study in Tanzania suggests.

The study focused on implementation of Option B+, a treatment protocol recommended by the World Health Organization (WHO) to encourage lifelong ART starting during pregnancy for HIV-positive women not already on this regimen. Researchers followed 10,161 HIV-positive pregnant women for a median of 37 months and as long as 53 months; all the women initiated Option B+ during pregnancy to help prevent HIV transmission to their babies.

Overall, the rate of viral suppression (less than 400 copies per mL) was 88.2% during the entire study period. It ranged from 85.1% in tests done over the first 11 months of follow up to 90.6% at 36 months or longer.

Using the WHO cutoff for viral suppression of 1,000 copies per mL, the overall viral suppression rate climbed to 90.1%, researchers report in The Lancet HIV.

"The findings of our study provide reassurance to clinicians in routine care settings in low and middle income countries that the virologic benefits of lifelong antiviral treatment started during pregnancy for prevention of mother-to-child transmission of HIV under the WHO's Option B+ recommendation are sustainable long-term," said lead study author Dr. Goodluck Willey Lyatuu of the Karolinska Institute in Stockholm, Sweden, and Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania.

The risk of virological failure declined the longer women were on treatment. Compared to the risk at 0-11 months after Option B+ initiation, it was lower (adjusted risk ratio 0.87) at 12-23 months, and lower still (aRR 0.63) at 36 months.

Some mothers had an increased risk for virological failure.

For example, women under 20 years old had a higher risk for virological failure than women aged 30 to 39 years (aRR 1.76). In addition, women starting Option B+ in their third trimester had a higher risk than those who began in the first trimester (aRR 1.28), and women with advanced HIV had a greater risk than women without advanced HIV (aRR 1.33).

"The findings shed light on areas of focus to further improve outcomes by addressing challenges among adolescent women, late presenters at antenatal care as well as improving couple HIV counseling and testing during antenatal care," Dr. Lyatuu said by email.

One limitation of the study was the lack of complete follow-up data on many of the participants, the study team notes. However, the results were consistent even when researchers only looked at variables with less than 30% missing data.

"The take-home message here is that lifelong antiretroviral therapy works to improve maternal health, and it works particularly well for women living with HIV who start treatment early in the course of their pregnancy and HIV infection and who remain in care," said Dr. Michael Herce, an assistant professor in infectious diseases at the University of North Carolina School of Medicine and the UNC Medical Center, in Chapel Hill.

But more still needs to be done to eradicate HIV in these vulnerable populations, Dr. Herce, who wasn't involved in the study, said by email.

"We need to do a better job of reaching those women who are being left behind by current approaches, including adolescents and young women living with HIV and other pregnant and breastfeeding women who can't access lifelong antiretroviral therapy due to the barriers they face at home, in the clinic, and in their communities and societies."

SOURCE: https://bit.ly/37RFYBB The Lancet HIV, online February 11, 2021.