Retention in care and viral suppression in pregnant/postpartum vs. nonpregnant/nonpostpartum women with HIV

Objective: To investigate retention in care, viral suppression, and virological failure in pregnant and postpartum women with HIV compared to nonpregnant/nonpostpartum women with HIV in Denmark, and to explore factors associated with adverse HIV care outcomes. Design: A nationwide registry-based cohort study. Methods: All women with HIV, who delivered in Denmark from 2000 to 2019, alongside a comparison group of nonpregnant/nonpostpartum women with HIV were included from the Danish HIV Birth Cohort and the Danish HIV Cohort Study and linked to national health registries. We assessed outcomes: retention in care (two HIV RNA or CD4 + measurements ≥90 days apart within a year), viral suppression (HIV RNA <200 copies/ml at the latest measurement), and virological failure (two consecutive HIV RNA measurements >200 copies/ml or one >1000 copies/ml). Incidence rate ratios evaluated group differences, and logistic regression analyzed factors linked to adverse outcomes. Results: We included 564 pregnant and 1705 nonpregnant/nonpostpartum women with HIV. Retention in care was significantly lower during pregnancy, especially for deliveries before 2014, and in the second postpartum year. No significant differences in viral suppression were found between groups after stratification by delivery year or in women with more than 1 year since HIV diagnosis. Pregnant women had higher rates of virological failure, while postpartum women had lower rates, significant only in the second postpartum year for women delivering before 2010. Conclusion: Based on CD4 + /HIV RNA measurements, retention in care was lower in pregnant and postpartum women, particularly in the second year. Reassuringly, viral suppression and virological failure rates were comparable.