Background
Safety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.
Objectives
To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.
Methods
In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (<50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.
Results
Among 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was <50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.
Conclusions
In virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes.
Background
Accurate nestling age is valuable for studies on nesting strategies, productivity, and impacts on reproductive success. Most aging guides consist of descriptions and photographs that are time consuming to read and subjective to interpret. The Western Bluebird (Sialia mexicana) is a secondary cavity-nesting passerine that nests in coniferous and open deciduous forests. Nest box programs for cavity-nesting species have provided suitable nesting locations and opportunities for data collection on nestling growth and development.
Methods
We developed models for predicting the age of Western Bluebird nestlings from morphometric measurements using model training and validation. These were developed for mass, tarsus, and two different culmen measurements.
Results
Our models were accurate to within less than a day, and each model worked best for a specific age range. The mass and tarsus models can be used to estimate the ages of Western Bluebird nestlings 0–10 days old and were accurate to within 0.5 days for mass and 0.7 days for tarsus. The culmen models can be used to estimate ages of nestlings 0–15 days old and were also accurate to within less than a day. The daily mean, minimum, and maximum values of each morphometric measurement are provided and can be used in the field for accurate nestling age estimations in real time.
Conclusions
The model training and validation procedures used here demonstrate that this method can create aging models that are highly accurate. The methods can be applied to any passerine species provided sufficient nestling morphometric data are available.
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