ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Antiretroviral Adherence, Elevated Viral Load, and Drug Resistance Mutations in Human Immunodeficiency Virus-infected Women Initiating Treatment in Pregnancy: A Nested Case-control Study.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 23 citations in OpenAlex.
- The Acceptability of a Real-Time Medication Monitoring-Based Digital Adherence Tool Among Young People Living with HIV in Malawi.AIDS and behavior · 2026Trial
- An optimized strategy triggered at the 2nd immunization visit to prevent HIV acquisition by breastfeeding: a phase 2 trial in Burkina Faso (PREVENIR-PEV).BMC infectious diseases · 2024Trial
- Facilitators and barriers to infant post-natal HIV prophylaxis, a qualitative sub-study of the PROMISE-EPI trial in Lusaka, Zambia.Frontiers in public health · 2023Trial
- Trial
- Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial.AIDS (London, England) · 2020Trial
- Evaluation of a Phone-Based Program to Increase Adherence to Antiretrovirals Among PLWH: A Pilot Study.AIDS and behavior · 2025Article
- Human Immunodeficiency Virus Viral Load Monitoring and Rate of Virologic Suppression Among Patients Receiving Antiretroviral Therapy in Democratic Republic of the Congo, 2013-2020.Open forum infectious diseases · 2023Article
- Small area analysis of HIV viral load suppression patterns in a high priority district (2012-2016), South Africa.PLOS global public health · 2023Article
- Development and validation of a scoring system for the prediction of HIV drug resistance in Hubei province, China.Frontiers in cellular and infection microbiology · 2023Article
- Retention in care and viral suppression in the PMTCT continuum at a large referral facility in western Kenya.AIDS and behavior · 2022Article
- HIV stigma limits the effectiveness of PMTCT in Guinea: the ANRS 12344-DIAVINA study.The Journal of antimicrobial chemotherapy · 2022Article
- Routine Antiretroviral Pharmacy Refill Information Can Predict Failure Postpartum in Previously Suppressed South African Women With HIV.Open forum infectious diseases · 2022Article
- The National Evaluation of Malawi's PMTCT Program (NEMAPP) study: 24-month HIV-exposed infant outcomes from a prospective cohort study.HIV medicine · 2022Article
- Impact of pre-existing drug resistance on risk of virological failure in South Africa.The Journal of antimicrobial chemotherapy · 2021Article
- Unintended pregnancy and viral suppression in pregnant women living with HIV.American journal of obstetrics & gynecology MFM · 2021Article
- Potential challenges to sustained viral load suppression in the HIV treatment programme in South Africa: a narrative overview.AIDS research and therapy · 2021Review
- Undisclosed exposure to antiretrovirals prior to treatment initiation: An exploratory analysis.Southern African journal of HIV medicine · 2021Article
- ART Adherence, Resistance, and Long-term HIV Viral Suppression in Postpartum Women.Open forum infectious diseases · 2020Article
Corrections and comments
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Authors and funding
17 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundElevated viral load (VL) early after antiretroviral therapy (ART) initiation appears frequently in pregnant and postpartum women living with human immunodeficiency virus; however the relative contributions of pre-ART drug resistance mutations (DRMs) vs nonadherence in the etiology of elevated VL are unknown.
methodsWithin a cohort of women initiating ART during pregnancy in Cape Town, South Africa, we compared women with elevated VL after initial suppression (cases, n = 80) incidence-density matched to women who maintained suppression over time (controls, n = 87). Groups were compared on pre-ART DRMs and detection of antiretrovirals in stored plasma.
resultsThe prevalence of pre-ART DRMs was 10% in cases and 5% in controls (adjusted odds ratio [aOR], 1.53 [95% confidence interval {CI}, .4-5.9]); all mutations were to nonnucleoside reverse transcriptase inhibitors. At the time of elevated VL, 19% of cases had antiretrovirals detected in plasma, compared with 87% of controls who were suppressed at a matched time point (aOR, 131.43 [95% CI, 32.8-527.4]). Based on these findings, we estimate that <10% of all elevated VL in the cohort may be attributable to pre-ART DRMs vs >90% attributable to ART nonadherence.
conclusionsDRMs account for a small proportion of all elevated VL among women occurring in the 12 months after ART initiation during pregnancy in this setting, with nonadherence appearing to drive most episodes of elevated VL. Alongside the drive for access to more robust antiretroviral agents in resource-limited settings, there is an ongoing need for effective strategies to support ART adherence in this patient population.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.