Pregnant and breastfeeding women: A priority population for HIV viral load monitoring

Landon Myer, Shaffiq Essajee, Laura N. Broyles, D. Heather Watts, Maia Lesosky, Wafaa M. El-Sadr, Elaine J. Abrams

With more than 18 million HIV-infected individuals having initiated antiretroviral therapy (ART) in low- and middle-income countries (LMICs) by the end of 2016, ensuring effective HIV care and treatment services is a global public health priority. Viral load (VL) quantification provides a direct measure of the effectiveness of ART, with a consistently elevated VL suggesting poor adherence or treatment failure and the need for intervention. In turn, HIV VL monitoring is now recognised as a key component of ART services in LMICs in World Health Organization (WHO) guidelines, with an emphasis on scaling up access to VL testing for ART programmes.

Although the importance of routine VL monitoring for HIV-infected individuals on ART is widely recognised, there has been minimal attention to VL monitoring in pregnancy and the postpartum period. Here we discuss key considerations for VL monitoring in pregnant and breastfeeding women in the context of expanding access to VL monitoring.

September 5, 2017
Year of publication
2017
Resource types
Journal and research articles
Tags
viral load monitoring, viral load suppression, antiretroviral therapy (ART), ART, adherence, pregnancy, breastfeeding, prevention of mother-to-child transmission (PMTCT), maternal disease progression, non-adherence, vertical transmission

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Background
Understanding the absolute and relative risk of human immunodeficiency virus type 1 (HIV) acquisition during pregnancy and the postpartum period can inform HIV prevention strategies for women.

Timely access to antiretroviral treatment (ART) is vital to ensuring safe motherhood and reducing vertical transmission. Treatment guidance and programming has changed dramatically in recent years.