Investigating the influence of pregnancy-induced changes in antiretroviral pharmacokinetics together with polymorphisms in drug disposition genes on viral decay dynamics in HIV positive women starting therapy late in pregnancy and postpartum

When HIV drugs are started before or early in pregnancy, mother-to-child transmission (MTCT) of HIV can be prevented. This is achieved by adequate suppression of the virus before the birth of the child and when breastfeeding. However, some women do not start taking these drugs early on because they become infected during pregnancy or lactation. This leads to there being detectable virus at the time of delivery, increasing MTCT risks. I recently showed that pregnancy increases the rate at which the body clears some HIV drugs used to prevent MTCT. Other authors have reported similar findings for other HIV drugs. While this may not cause any problem in women with no detectable virus before pregnancy, it may affect the rate at which the HIV virus is cleared from the body in those starting treatment late and may elevate MTCT risks.

In this study I will find out whether the changes in drug exposure caused by pregnancy or genetic factors have any effect on the rate at which the HIV virus is removed from the body. HIV positive pregnant or recently postpartum women will be recruited from four Nigerian hospitals and followed up until breastfeeding ends.

This grant was awarded under the scheme's previous name of Training Fellowships in Public Health and Tropical Medicine.