HIV in Pregnancy: How Pharmacists Can Improve Care

Pregnancy is an important time for women with human immunodeficiency virus (HIV) to receive adequate prenatal care, antiretroviral therapy (ART), and postpartum HIV care to improve clinical outcomes for themselves and their babies.

While HIV treatment before, during, and after pregnancy can lead to viral suppression and better continuation of care, many women are not reaping these benefits, 2 studies suggests.

However, pharmacists in particular can help pregnant patients stay adherent to HIV treatment, according to study authors Joëlla Adams, MPH, and Florence Momplaisir, MD, MSHP.

“Pharmacists can help their pregnant HIV-infected patients by recognizing that women frequently fall out of care and virologically rebound during the immediate postpartum period,” Adams and Dr. Momplaisir told Pharmacy Times. “Counseling on the importance of adhering to antiretroviral regimens and sustained engagement in HIV care can have a positive impact on long-term clinical outcomes.”

While most health care providers do speak with HIV-infected patients about the importance of treatment adherence, Dr. Momplaisir said it could be useful for patients to also hear it from pharmacists, who might have more time to consult with patients. She believes pharmacists would be a great resource for patients during pregnancy and postpartum.

“It’s obviously a critical time for women to be adherent to decrease their risk of transmission to their baby,” she noted.

Dr. Momplaisir also called for more investigation into ART during pregnancy, including optimal dosing, and she said pharmacists could provide expertise in this area.

“Having a pharmacist as part of the health care team is certainly very valuable—for any patients, but particularly for those women,” Dr. Momplaisir told Pharmacy Times. “It’s usually a time of chaos, so having that extra hand would be great.”

Dr. Momplaisir was the lead author of a recent retrospective study that examined 836 mother-to-child pairs, including 656 women with HIV, in Philadelphia, Pennsylvania, from 2005 to 2013.

She and her fellow researchers considered quality of prenatal care, timing of HIV diagnosis, whether or not the woman received antiretroviral therapy (ART), and viral suppression at delivery.

One-quarter of the group was diagnosed with HIV during pregnancy. The researchers classified 39% of the mothers’ prenatal care as adequate, 38% as intermediate, and 23% as inadequate.

While 85% of the mother-to-child pairs received ART during pregnancy, only 52% achieved viral suppression at delivery.

Women who were diagnosed with HIV during pregnancy were less likely to receive ART and achieve suppression than those diagnosed prior to becoming pregnant. Those with inadequate prenatal care were also less likely to receive ART and achieve viral suppression than their peers who received adequate prenatal care, according to the study published in PLOS ONE.

“Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period,” the researchers concluded.

The second study, led by Adams and published in Clinical Infectious Diseases, examined 695 deliveries, including 561 women with HIV, between 2005 and 2011.

The researchers looked at the patients’ age, race, substance abuse, ART during pregnancy, timing of diagnosis, previous pregnancy with HIV, prenatal care, and postpartum HIV care engagement.

They found that only 38% of women engaged in HIV care within 90 days after delivery of their child. In addition, 39% and 31% continued care and were virally suppressed at 1 year postpartum, and 25% and 34% stayed in care and were virally suppressed at 2 years postpartum.

Thus, the researchers determined that women who receive HIV care within 90 days after delivery are more likely to be virologically suppressed at 1 and 2 years postpartum.

These results suggest that interventions should target women quickly after delivery in order to keep them engaged in HIV care and improve their clinical outcomes.

“Although we have made enormous achievements in reducing mother-to-child transmission of HIV in the United States, there is more work to be done to completely eliminate that risk and to ensure that HIV-infected women of child bearing age are living healthy and productive lives,” Dr. Momplaisir stated in a press release.