Characteristics associated with suboptimal viral suppression at delivery in human immunodeficiency virus-1-infected pregnant women.

OBJECTIVE: This study was undertaken to determine clinical characteristics and factors associated with suboptimal viral suppression at delivery in human immunodeficiency virus (HIV)-infected women. STUDY DESIGN: All HIV-infected women who delivered at a single urban tertiary care center from January 1999 to June 2004 were studied. Women were divided into 2 groups based on HIV viral load (VL) proximate to delivery: VL < 1000 copies per milliliter and VL > or = 1000 copies per milliliter. Demographic and clinical factors were analyzed and compared between the 2 groups. RESULTS: A total of 146 women had adequate data available for analysis: 102 (69.9%) had VL < 1000 copies per milliliter and 44 (30.1%) had VL > or = 1000 copies per milliliter at delivery. Women with a viral load > or = 1000 copies per milliliter at delivery were more likely to have a baseline viral load VL > or = 10,000 copies per milliliter (66.7% vs 32%, P < .001) and less likely to report medication adherence, (50% vs 87.8%, P < .001). CONCLUSION: Our findings support the concept that in addition to antiviral medical therapy, intervention to improve adherence and maintaining a low baseline VL are key components to VL suppression in pregnancy.