{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T17:41:53Z","timestamp":1775151713523,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2013,8,7]],"date-time":"2013-08-07T00:00:00Z","timestamp":1375833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"UCSF-CTSI","award":["UL1 TR000004"],"award-info":[{"award-number":["UL1 TR000004"]}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,11]]},"abstract":"Objective<\/jats:title>To compare time to achieve viral load\u00a0<400\u00a0copies\/ml and <1000\u00a0copies\/ml in HIV<\/jats:styled-content>\u2010infected antiretroviral (ARV<\/jats:styled-content>) \u2010naive versus ARV<\/jats:styled-content>\u2010experienced pregnant women on highly active antiretroviral therapy (HAART<\/jats:styled-content>).<\/jats:p><\/jats:sec>Design<\/jats:title>Retrospective cohort study.<\/jats:p><\/jats:sec>Setting<\/jats:title>Three university medical centers, USA<\/jats:styled-content>.<\/jats:p><\/jats:sec>Population<\/jats:title>HIV<\/jats:styled-content>\u2010infected pregnant women initiated or restarted on HAART<\/jats:styled-content> during pregnancy.<\/jats:p><\/jats:sec>Methods<\/jats:title>We calculated time to viral load\u00a0<400\u00a0copies\/ml and <1000\u00a0copies\/ml in HIV<\/jats:styled-content>\u2010infected pregnant women on HAART<\/jats:styled-content> who reported at least 50% adherence, stratifying based on previous ARV<\/jats:styled-content> exposure history.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Time to HIV<\/jats:styled-content> viral load\u00a0<400\u00a0copies\/ml and <1000\u00a0copies\/ml.<\/jats:p><\/jats:sec>Results<\/jats:title>We evaluated 138 HIV<\/jats:styled-content>\u2010infected pregnant women, comprising 76 ARV<\/jats:styled-content>\u2010naive and 62 ARV<\/jats:styled-content>\u2010experienced. Ninety\u2010three percent of ARV<\/jats:styled-content>\u2010naive women achieved a viral load\u00a0<\u00a0400\u00a0copies\/ml during pregnancy compared with 92% of ARV<\/jats:styled-content>\u2010experienced women (P<\/jats:italic>\u00a0=\u00a00.82). The median number of days to achieve a viral load\u00a0<\u00a0400\u00a0copies\/ml in the ARV<\/jats:styled-content>\u2010naive cohort was 25.0 (range 3.5\u2013133; interquartile range 16\u201334) days compared with 27.0 (range 8\u2013162.5; interquartile range 18.5\u201354.3) days in the ARV<\/jats:styled-content>\u2010experienced cohort (P<\/jats:italic>\u00a0=\u00a00.02). In a multiple predictor analysis, women with higher adherence (adjusted relative hazard [aRH<\/jats:styled-content>] per 10% increase in adherence 1.29, 95% confidence interval [CI<\/jats:styled-content>] 1.08\u20131.54, P<\/jats:italic>\u00a0=\u00a00.01) and receiving a non\u2010nucleotide reverse transcriptase inhibitor (NNRTI<\/jats:styled-content>) \u2010based regimen (aRH<\/jats:styled-content> 2.48, 95% CI<\/jats:styled-content> 1.33\u20134.63, P<\/jats:italic>\u00a0=\u00a00.01) were more likely to achieve viral load\u00a0<400\u00a0copies\/ml earlier. Increased baseline HIV<\/jats:styled-content> log10<\/jats:sub> viral load was associated with a later time of achieving viral load\u00a0<400\u00a0copies\/ml (aRH<\/jats:styled-content> 0.60, 95% CI 0.39\u20130.92, P<\/jats:italic>\u00a0=\u00a00.02). In a corresponding model of time to achieve viral load\u00a0<1000\u00a0copies\/ml, adherence (aRH<\/jats:styled-content> per 10% increase in adherence 1.79, 95% CI<\/jats:styled-content> 1.34\u20132.39, P<\/jats:italic>\u00a0<\u00a00.001), receipt of NNRTI<\/jats:styled-content> (aRH<\/jats:styled-content> 2.95, 95% CI<\/jats:styled-content> 1.23\u20137.06, P<\/jats:italic>\u00a0=\u00a00.02), and CD<\/jats:styled-content>4 cell count (aRH<\/jats:styled-content> per 50 count increase in CD<\/jats:styled-content>4 1.12, 95% CI<\/jats:styled-content> 1.03\u20131.22, P<\/jats:italic>\u00a0=\u00a00.01) were associated with an earlier time to achieve viral load below this threshold. Increasing baseline HIV<\/jats:styled-content> log10<\/jats:sub> viral load was associated with a longer time of achieving viral load\u00a0<1000\u00a0copies\/ml (aRH<\/jats:styled-content> 0.54, 95% CI<\/jats:styled-content> 0.34\u20130.86, P<\/jats:italic>\u00a0=\u00a00.01). In multiple predictor models, previous ARV<\/jats:styled-content> exposure was not significantly associated with time to achieve viral load below thresholds of <400\u00a0copies\/ml and <1000 copies\/ml.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Pregnant women with \u226550% adherence, whether ARV<\/jats:styled-content>\u2010naive or ARV<\/jats:styled-content>\u2010experienced, on average achieve a viral load\u00a0<400\u00a0copies\/ml within a median of 26\u00a0days and a viral load of\u00a0<1000\u00a0copies\/ml within a median of 14\u00a0days of HAART<\/jats:styled-content> initiation. Increased adherence, receipt of NNRTI<\/jats:styled-content>\u2010based regimen and lower baseline HIV<\/jats:styled-content> log10<\/jats:sub> viral load were all statistically significant predictors of earlier time to achieve viral load\u00a0<400\u00a0copies\/ml and <1000\u00a0copies\/ml. Increased CD<\/jats:styled-content>4 count was statistically significant as a predictor of earlier time to achieve viral load\u00a0<1000\u00a0copies\/ml.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12226","type":"journal-article","created":{"date-parts":[[2013,8,7]],"date-time":"2013-08-07T15:10:09Z","timestamp":1375888209000},"page":"1534-1547","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Time to viral load suppression in antiretroviral\u2010naive and \u2010experienced HIV<\/scp>\u2010infected pregnant women on highly active antiretroviral therapy: implications for pregnant women presenting late in gestation"],"prefix":"10.1111","volume":"120","author":[{"given":"N","family":"Aziz","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Stanford University School of Medicine Stanford CA USA"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Sokoloff","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Kornak","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"NV","family":"Leva","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ML","family":"Mendiola","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Levison","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Feakins","sequence":"additional","affiliation":[{"name":"Department of Medicine Positive Health Program at San Francisco General Hospital University of California San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Shannon","sequence":"additional","affiliation":[{"name":"University of Hawaii at M\u00e3noa School of Nursing and Dental Hygiene Honolulu HI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Cohan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,8,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00042560-200204150-00009"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282f3d63c"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282f9b67a"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181cf9979"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1093\/oxfordjournals.aje.a117601","article-title":"Estimated timing of mother\u2010to\u2010child human immunodeficiency virus type 1 (HIV\u20101) transmission by use of a Markov model. The HIV Infection in Newborns French Collaborative Study Group","volume":"142","author":"Rouzioux C","year":"1995","journal-title":"Am J Epidemiol"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199910010-00016"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200501010-00016"},{"key":"e_1_2_7_9_1","unstructured":"British HIV Association.Management of HIV infection in pregnant women.2008[www.bhiva.org]. Accessed 1 November 2011."},{"key":"e_1_2_7_10_1","unstructured":"World Health Organization.Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants.2010[www.who.int]. Accessed 1 November 2011."},{"key":"e_1_2_7_11_1","unstructured":"Antiretroviral Pregnancy Registry Steering Committee.Antiretroviral pregnancy registry international interim report for 1 Jan 1989 \u2013 31 January 2011.Wilmington NC:Registry Coordinating Center.2011[www.APRegistry.com]. Accessed 1 November 2011."},{"key":"e_1_2_7_12_1","unstructured":"Perinatal HIV Guidelines Working Group.Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV\u2010Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. September 14 2011; pp 1\u2013207. [http:\/\/aidsinfo.nih.gov\/contentfiles\/lvguidelines\/PerinatalGL.pdf]. Accessed November 1 2011."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/373117a0"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/387188a0"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/314670"},{"key":"e_1_2_7_16_1","first-page":"S102","article-title":"Time to clinically significant viral suppression in HIV\u2010infected pregnant women. Presented at 24th Annual Meeting of the Society of Maternal Fetal Medicine; 2004; New Orleans, Louisiana","volume":"189","author":"Wright RL","year":"2003","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1086\/518284"},{"key":"e_1_2_7_18_1","unstructured":"SchalkwykJ Chaworth\u2010MustersT MaanE GilgoffS TatumS BurdgeD et\u00a0al.Time to HIV suppression with HAART in pregnancy. Presented at the 14th Annual Meeting of the Conference on Retroviruses and Opportunistic Infections.2007;Los Angeles California. [www.retroconference.org\/2007\/Abstracts\/28669.htm]. Accessed November 2011."},{"key":"e_1_2_7_19_1","unstructured":"BellC DouglasM GilleeceY DesmondN TaylorGP.Early viral load reduction in pregnant women differs according to antiretroviral regimen. Presented at the 15th Annual Meeting of the Conference on Retroviruses and Opportunistic Infections.2008;Boston Massachusetts. [www.retroconference.org\/2008\/Abstracts\/31977.htm]. Accessed November 2011."},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1157\/13125637"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1155\/2009\/621780"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318219a3fd"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2008.0263"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(01)00412-X"},{"key":"e_1_2_7_25_1","unstructured":"Stanford University HIV Drug Resistance Database. [http:\/\/hivdb.stanford.edu]. Accessed April 2009."},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-1353-0"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0906626"},{"key":"e_1_2_7_28_1","unstructured":"'BryantA CollinghamJ TillM GarciaP.Virologic and clinical outcomes in HIV\u2010infected pregnant women: directly observed therapy can overcome barriers to care. Presented at the 11th Annual Meeting of the Conference on Retroviruses and Opportunistic Infections.2004;San Francisco California. [www.retroconference.org\/2004\/cd\/Abstract\/922.htm]. Accessed November 2011."},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010154"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.07.007"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.09.023"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1300\/J013v44n04_04"},{"issue":"14","key":"e_1_2_7_33_1","first-page":"1","article-title":"Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health\u2010care settings","volume":"55","author":"Branson BM","year":"2006","journal-title":"MMWR Recommen Rep"},{"key":"e_1_2_7_34_1","first-page":"CD005479","article-title":"Efficacy and safety of cesarean delivery for prevention of mother\u2010to\u2010child transmission of HIV\u20101","volume":"4","author":"Read JS","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000291577.01569.4c"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.02.034"}],"container-title":["BJOG: An International Journal of Obstetrics & Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1471-0528.12226","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.12226","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T04:27:21Z","timestamp":1696393641000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.12226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8,7]]},"references-count":35,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2013,11]]}},"alternative-id":["10.1111\/1471-0528.12226"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.12226","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8,7]]},"assertion":[{"value":"2013-02-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-08-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}