992 – Childhood Exposure to Violence and Pregnancy-to-Postpartum Viral Load of US Women With HIV

Background

Experiences of childhood physical and sexual assault are prevalent in people living with HIV, yet relationships to antepartum and postpartum viral load (VL) are understudied. We evaluated the relationship of childhood physical or sexual assault (CPA/CSA) to VL during pregnancy and postpartum among participants in the Women’s Health Supplement to the Surveillance Monitoring for ART Toxicities (SMARTT) study.

Methods

In this prospective study, women at 21 SMARTT sites in the US and Puerto Rico who were >18 years old, living with HIV and pregnant or up to five years postpartum in 2013-2018 were eligible. CPA/CSA, assessed at one-year postpartum via interview, was defined as an affirmative response to having been physically and/or sexually assaulted in childhood. VL measures from 3 months before the last menstrual period (LMP) date until 15 months after delivery were abstracted from medical records. Pregnancy through postpartum log₁₀ RNA trajectories by CPA/CSA were visualized with LOESS plots. Unsuppressed VL (≥50 copies/mL) at LMP, delivery, and 1 year postpartum and unsuppressed VL during pregnancy and postpartum (any measure ≥50 copies/mL in these periods) were compared in those with vs. without CPA/CSA. Log binomial regression models with generalized estimating equations were fit to estimate crude and adjusted relative risks and 95% confidence intervals (CI) for unsuppressed VL in those with vs. without CPA/CSA.

Results

Among 518 pregnancies (among women mean age: 29 years), 34% were among participants who reported experiencing CPA/CSA (CPA: 23.4%, CSA: 27.6%, CPA and CSA:17.0%). In pregnancies of women with vs. without CPA/CSA the frequency of unsuppressed VL was similar at LMP (49% vs 46%) and delivery (21% vs 18%), but higher at the 1-year postpartum time point in pregnancies of women with CPA/CSA (39%) than in those of women without CPA/CSA (29%). A visual summary of log₁₀VL stratified by CPA/CSA is displayed in the Figure. The frequency of unsuppressed VL during pregnancy was similar among pregnancies of women with vs. without CPA/CSA. However, unsuppressed VL at any point in the first year postpartum period was more frequent in postpartum periods of women with (53%) than in those without (43%) CPA/CSA (aRR:1.22, 95% CI:1.00, 1.50). 

Conclusions

CPA/CSA was prevalent among women living with HIV and associated with elevated risk of postpartum unsuppressed VL. Trauma-informed approaches are needed and may help sustain care engagement and viral suppression postpartum.

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