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Background <p>The post-delivery period is a critical window for sustaining maternal viral suppression (VS) to prevent vertical transmission (VT) of HIV during breastfeeding. Despite Ghana’s national scale-up of dolutegravir-based antiretroviral therapy, limited data exist on viral load suppression and infant HIV outcomes in the year post-delivery. We aimed to determine the proportion of women who achieved and maintained a suppressed viral load (VL) (≤ 1000 copies/mL) and an undetectable VL (&lt; 20 copies/mL) at 12 months post-delivery and examine associations between maternal characteristics and VL categories.</p> Methods <p>We conducted a prospective longitudinal cohort study among 120 women living with HIV receiving ART across two tertiary hospitals in Ghana. Women were enrolled during late pregnancy or early post-delivery and followed up at 6 weeks and 3-, 6-, and 12-months post-delivery, during which maternal VL was monitored. Infant HIV status was documented at 6 weeks and 9 months in accordance with national guidelines. Our co-primary outcomes were VL suppression and undetectable VL at 12 months.</p> Results <p>The median maternal age was 31.0 years (28.0, 36.3), and nearly half of the participants had attained only primary-level education (58/120; 46.7%). At 12 months post-delivery, 65 participants (54.2%) had documented VS, and out of this, 41 (34.2%) had an undetectable VL. Two cases of VT of HIV were documented: one at 6 weeks (maternal VL 669 copies/mL) and another at 6 months (maternal VL 64 copies/mL), underscoring the transmission risk even with low-level viremia. VL data were missing among 49 participants (40.8%) despite follow-up efforts. Women on the tenofovir/lamivudine/dolutegravir regimen were more likely to achieve suppression than were those on the regimen without an integrase inhibitor, <i>p</i> = 0.04.</p> Conclusions <p>Just over half of women achieved VS at 12 months post-delivery. VT occurred even at low levels of maternal viremia, underscoring the importance of sustained VL monitoring and optimisation of antiretroviral therapy during the post-delivery period.</p> Clinical trial number <p>Not applicable.</p>

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Viral load suppression among pregnant and breastfeeding women living with HIV in Ghana: a prospective longitudinal study

  • 期刊论文

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  • 发表日期：

    2026年4月14日

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  • Joycelyn Assimeng Dame,
  • Kira J. Nightingale,
  • Promise Sefogah,
  • Islynn Aggrey,
  • Derartu Ahmed,
  • Adwoa K. A. Afrane,
  • Elizabeth D. Lowenthal

摘要

Background

The post-delivery period is a critical window for sustaining maternal viral suppression (VS) to prevent vertical transmission (VT) of HIV during breastfeeding. Despite Ghana’s national scale-up of dolutegravir-based antiretroviral therapy, limited data exist on viral load suppression and infant HIV outcomes in the year post-delivery. We aimed to determine the proportion of women who achieved and maintained a suppressed viral load (VL) (≤ 1000 copies/mL) and an undetectable VL (< 20 copies/mL) at 12 months post-delivery and examine associations between maternal characteristics and VL categories.

Methods

We conducted a prospective longitudinal cohort study among 120 women living with HIV receiving ART across two tertiary hospitals in Ghana. Women were enrolled during late pregnancy or early post-delivery and followed up at 6 weeks and 3-, 6-, and 12-months post-delivery, during which maternal VL was monitored. Infant HIV status was documented at 6 weeks and 9 months in accordance with national guidelines. Our co-primary outcomes were VL suppression and undetectable VL at 12 months.

Results

The median maternal age was 31.0 years (28.0, 36.3), and nearly half of the participants had attained only primary-level education (58/120; 46.7%). At 12 months post-delivery, 65 participants (54.2%) had documented VS, and out of this, 41 (34.2%) had an undetectable VL. Two cases of VT of HIV were documented: one at 6 weeks (maternal VL 669 copies/mL) and another at 6 months (maternal VL 64 copies/mL), underscoring the transmission risk even with low-level viremia. VL data were missing among 49 participants (40.8%) despite follow-up efforts. Women on the tenofovir/lamivudine/dolutegravir regimen were more likely to achieve suppression than were those on the regimen without an integrase inhibitor, p = 0.04.

Conclusions

Just over half of women achieved VS at 12 months post-delivery. VT occurred even at low levels of maternal viremia, underscoring the importance of sustained VL monitoring and optimisation of antiretroviral therapy during the post-delivery period.

Clinical trial number

Not applicable.