OBJECTIVE:

Unintended pregnancies are common among women living with HIV, but there are no data on their long-term impact on treatment outcomes. In a cohort of women initiating antiretroviral therapy (ART) during pregnancy, we examined the association between the intendedness of the current pregnancy, measured antenatally, and elevated viral load (VL) up to five years postpartum.

DESIGN:

Prospective study with enrolment at entry into antenatal care and follow-up at study visits separate from routine care.

METHODS:

At enrolment women completed the London Measure of Unplanned Pregnancy. Mixed effects models examined the impact of the intendedness of the pregnancy (planned versus each of unplanned or ambivalent, respectively) on VL ≥50 copies/mL across postpartum study visits.

RESULTS:

Overall, 459 women were followed for a median of 43 months postpartum, contributing 2535 VL measures (median per woman: 6). Ambivalent and unplanned pregnancy were commonly reported (20% and 60%, respectively), and the proportion of women with elevated VL increased over time (16% at 6 weeks to 43% by 36-60 months postpartum). Compared to those reporting a planned pregnancy, elevated VL was more common among women reporting an unplanned pregnancy [odds ratio (OR): 2.87; 95% confidence interval (CI): 1.46-5.64], with a trend towards a higher odds among those reporting ambivalence (OR: 2.19; 95% CI: 0.97-4.82); associations persisted after adjustment for a wide range of demographic, clinical and psychosocial factors.

CONCLUSIONS:

These novel data suggest that unplanned pregnancy may be a prevalent and persistent predictor of poor ART outcomes among women initiating ART during pregnancy.