Virologic and immunologic response following antiretroviral therapy initiation among pregnant and postpartum women with acute HIV-1 infection: MOPDB0101

Alison L. Drake1, John Kinuthia7, Daniel Matemo7, R. Scott McClelland1,2,3, Barbra Richardson4, Julie Overbaugh6, Grace John-Stewart1,2,3,5

Departments of Global Health1, Medicine2, Epidemiology3, Biostatistics4, and Pediatrics5, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center,

Human Biology, Seattle, WA6 ; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya7

No conflicts of interest to disclose

Acknowledgements: Mama Salama Study participants and study staff, the Kenyan Ministry of Health, CDC/KEMRI, and the Ahero and Bondo District Hospitals

Funding provided by NIH P01 HSD 064915 and CFAR P30 AI27757

Objective and population: Characterize virologic and immunologic responses among HIV-1 infected women with acute HIV-1 in pregnancy or postpartum initiating ART

Study design and site: Prospective cohort study; Western Kenya

Laboratory methods: Serial HIV-1 RNA nucleic acid amplification tests (NAATS); CD4

Statistical methods: Linear mixed effects models to measure changes in HIV-1 RNA

Clinical and virologic characteristics post HIV-1 infection

n n (%) or Median (IQR)

Initiated ARTAt diagnosis

2524

24 (96)21 (88)

HIV-1 RNA levels at ART initiation (log10 copies/mL) 19 5.14 (4.22 – 5.68)

Time to viral suppression (days)* 23 166 (120, NA)

CD4 count (cells/mm3)At diagnosis

6 months post-diagnosis6 month change

251818

572 (450 – 764)831 (488 – 1066)

170 (21 – 375)

• HIV-1 incidence 1.9% (25/1304); incidence rate 2.35 per 100 PY• 12 (48%) infections detected during pregnancy

*< 2.17 log10 copies/mL (150 copies/mL)

HIV-1 RNA levels post-ART initiation

ART initiation 3 months post-ART0

1

2

3

4

5

3.96

3.36

4.48

2.62

Infected during pregnancyInfected postpartum

HIV

RN

A (

log

10

co

pie

s/m

l)

HIV-1 RNA levels by pregnancy status*2

46

8lo

g10

co

pies

/mL

0 60 120 180 240 300 360Days since ART initiation

Pregnancy PostpartumLowess curve, pregnancy Lowess curve, postpartum

-0.2

-0.62

Monthly rate of change**

* Among 18 women with ≥2 plasma samples** Infected during pregnancy vs. infected postpartum; p=0.06 Lower limit of detection

• HIV-1 RNA levels ~0.4 log10 higher in acute infection compared to other chronically infected cohorts

• ART acceptable, resulted in rapid viral decline• Prompt ART in acute infection important for PMTCT• Long-term follow-up needed to assess durability of viral suppression

Conclusions