Abstract
OBJECTIVE: In this study, we explore changes in the demographic and clinical characteristics of pregnant people living with HIV, and their post-partum HIV outcomes between 2000 and 2018. METHODS: We described pregnancies resulting in a live birth from the linked UK CHIC/ISOSS dataset in three calendar periods (2000-2006; 2007-2012; 2013-2018). Thereafter, we explored median CD4 count change and viral rebound from delivery to 12 months post-partum. RESULTS: In total, 4341 pregnancies were included. Maternal age increased from 31 (IQR: 28-35) years in 2000-2006 to 34 (IQR: 30-37) years in 2013-2018. Those conceiving in the most recent period had been diagnosed with HIV for longer (2000-2006: 3.0 years to 2013-2018: 7.5 years), had a higher median CD4 count (431-583 cells/mm(3)), and median nadir CD4 count (219-260 cells/mm(3)); they were also more likely to have initiated ART prior to estimated conception (70.1%-92.3%), and have a suppressed conception viral loads (VL) (56.6%-82.0%). There was no difference in median CD4 count change over the three calendar periods (2000-2006: +60 [IQR: -44, +179]; 2007-2012: +51 [-45, +172]; 2013-2018: +28 [-100, +175] cells/mm(3); p = 0.12). The cumulative proportion of people with viral rebound at 12 months post-delivery was reduced in 2013-2018 (8.2%) when compared with previous periods (2000-2006: 28.1%; 2007-2012: 19.5%). CONCLUSION: Clinical management of pregnant people has changed over time, resulting in positive trends in this study both within pregnancy and post-partum. Further work needs to understand what barriers remain for those who do not achieve optimal management of HIV in the post-partum period.