Live Birth Linked to Greater HIV Care Engagement in Europe

Pregnancies that resulted in a live birth among women living with HIV in England, Wales, and Northern Ireland had a positive association with uptick in postpartum HIV care, reports a new study in The Lancet HIV.

The authors used data on participants in the UK Collaborative HIV Cohort (CHIC) study who reported a live birth—only the first live birth per woman after their HIV status was reported—to the National Surveillance of HIV in Pregnancy and Childhood between January 1, 2000, and December 31, 2017. The finding is especially important in light of previous CHIC data showing the year after giving birth is associated with a higher risk of viral rebound compared with a nonpregnant control group.

“In the UK, pregnant women are expected to continue attending HIV care concurrently with antenatal care,” the authors noted. Their 1:1 matched cohort study compared engagement in HIV care between pregnant (n = 1116 pairs) and nonpregnant (n = 1116) women as it related to clinic attendance before, during, and after pregnancy, with pseudo conception dates established for the nonpregnant cohort. The median (interquartile range) age of all participants was 34 (30-38) years and most (80.1%) were Black African.

Overall, 69,330 persons-months of follow-up were recorded, with 25,412 in the before-pregnancy stage; 18,897 during pregnancy; and 25,021 after pregnancy. Whereas proportion of time engaged in care displayed an uptick among the pregnant cohort, levels remaine stable among the nonpregnant group:

• During pregnancy:
  • Pregnant cohort: 90.5% (8477/9371 person-months)
  • Nonpregnant cohort: 78.3% (7463/9526 person-months)
• After pregnancy:
  • Pregnant cohort: 84.6% (10,501/12,407 person-months)
  • Nonpregnant cohort: 78.4% (9892/12,614 person-months)
• Before pregnancy/pseudo pregnancy:
  • Pregnant cohort: 78.5% (9979/12,707 person-months)
  • Nonpregnant cohort: 76.3% (9688/12,705 person-months)

From baseline to after follow-up, CD4 count, suppressed viral load, hepatitis B/C diagnosis, having an AIDS-defining illness, and percentage who ever initiated antiretroviral therapy (ART) were similar between the groups.

However, after adjusting for nadir CD4 count and individual study status (case or control), the pseudo pregnancy/pregnancy and after pseudo pregnancy/pregnancy stages had 67% and 17% greater chances, respectively, or engaging in HIV care. Further testing for interaction showed even higher odds of HIV care engagement study status, with higher totals seen during and after pregnancy among the pregnant cohort, at 3.32 (95% CI, 2.68-4.12) and 1.49 (95% CI, 1.24-1.79). For this outcome among the nonpregnant cohort, no differences were seen, considering the numbers before their pseudo pregnancy.

The authors noted that while a drop was seen in HIV care engagement after pregnancy, these numbers were still “significantly higher” compared with before pregnancy. They attribute this to women living with HIV adhering to pregnancy-associated, multidisciplinary, enhanced care meant to keep them engaged in their care while pregnant and that there may be reduced stigma around attending clinic appointments for a pregnancy vs in connection with HIV status. In turn, this can have a positive effect on their likelihood to remain engaged in HIV care following a live-birth pregnancy.

However, because the same results were not seen in the nonpregnant cohort, “it is therefore important to understand the drivers of this sustained engagement in HIV care among pregnant women into the postpartum period to maximize engagement in HIV care for all women living with HIV regardless of reproductive status.,” the authors concluded.

Reference

Okhai H, Tariq S, Burns F, et al. Association of pregnancy with engagement in HIV care among women with HIV in the UK: a cohort study. Lancet HIV. Published online November 8, 2021 doi:10.1016/ S2352-3018(21)00194-6