Loss to follow-up among HIV-infected pregnant women initiating HIV treatment is a huge challenge

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On Tuesday at the 19th Conference on Retroviruses and Opportunistic Infections, Dr. Landon Myer presented data from a study of 29,653 HIV infected women initiating antiretroviral therapy (ART) in the public sector in South Africa from 2002 to 2009.  The aim of the study was to compare loss to follow-up rates of pregnant women and non-pregnant women initiating ART.  Myer noted the multiple benefits of initiating ART in pregnant women including reducing maternal morbidity and mortality, preventing mother-to-child HIV transmission and preventing “horizontal” transmission to sexual partners. He acknowledged that patients on ART in South Africa dropping out of care is a huge concern and that loss to follow-up is increasing as the number of patients on ART increases.

Overall, 6.6 percent or 1,954 women in the study were pregnant when ART was initiated. The pregnant women were younger and had less-advanced HIV disease than their non-pregnant counterparts.  Women who were pregnant when ART was initiated were less likely to die than then those who were not pregnant— three percent mortality in the pregnant group compared to nine percent in non-pregnant group.  This difference remained when analyses stratified the groups by age, CD4 count, World Health Organization-defined disease stage and baseline viral load.  However, the pregnant women were significantly more likely to be lost to follow-up (19 percent) compared to women who were not pregnant when ART was initiated (11 percent).

The authors concluded that loss to follow-up is the principal threat to retaining pregnant women in ART services.  Interventions are needed to promote retention of women initiating ART in pregnancy.

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