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Infectious Diseases in Obstetrics and Gynecology
Volume 2015, Article ID 362357, 9 pages
http://dx.doi.org/10.1155/2015/362357
Research Article

The Effects of Viral Load Burden on Pregnancy Loss among HIV-Infected Women in the United States

1Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
2Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
3Department of Obstetrics & Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
4Department of Obstetrics & Gynecology, Georgetown University, Washington, DC 20007, USA
5Departments of Clinical Pharmacy, Medicine Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA
6Department of Obstetrics and Gynecology, John H. Stroger Hospital of Cook County, Chicago, IL 60612, USA
7Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
8Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30322, USA
9Schools of Nursing and Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA
10Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
11School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA

Received 28 May 2015; Revised 29 September 2015; Accepted 30 September 2015

Academic Editor: Faustino R. Perez-Lopez

Copyright © 2015 Jordan E. Cates et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. To evaluate the effects of HIV viral load, measured cross-sectionally and cumulatively, on the risk of miscarriage or stillbirth (pregnancy loss) among HIV-infected women enrolled in the Women’s Interagency HIV Study between 1994 and 2013. Methods. We assessed three exposures: most recent viral load measure before the pregnancy ended, log10 copy-years viremia from initiation of antiretroviral therapy (ART) to conception, and log10 copy-years viremia in the two years before conception. Results. The risk of pregnancy loss for those with log10 viral load >4.00 before pregnancy ended was 1.59 (95% confidence interval (CI): 0.99, 2.56) times as high as the risk for women whose log10 viral load was ≤1.60. There was not a meaningful impact of log10 copy-years viremia since ART or log10 copy-years viremia in the two years before conception on pregnancy loss (adjusted risk ratios (aRRs): 0.80 (95% CI: 0.69, 0.92) and 1.00 (95% CI: 0.90, 1.11), resp.). Conclusions. Cumulative viral load burden does not appear to be an informative measure for pregnancy loss risk, but the extent of HIV replication during pregnancy, as represented by plasma HIV RNA viral load, predicted loss versus live birth in this ethnically diverse cohort of HIV-infected US women.