Antiretroviral Treatment in Pregnancy: A Six-Year Perspective on Recent Trends in Prescription Patterns, Viral Load Suppression, and Pregnancy Outcomes

Abstract

The aim of the study was to describe the recent trends in antiretroviral treatment in late pregnancy and the sociodemographic changes among pregnant women with HIV over the last 6 years. Data from the National Program on Surveillance on Antiretroviral Treatment in Pregnancy in Italy were grouped per calendar year, and changes in antiretroviral treatment, population characteristics, maternal immunovirologic status and newborn clinical parameters were analyzed. A total of 981 HIV-infected mothers who delivered between 2002 and 2008 were evaluated. The proportion of women receiving at least three antiretroviral drugs at delivery increased significantly from 63.0% in 2002 to 95.5% in 2007-2008, paralleled by a similar upward trend in the proportion of women who achieved complete viral suppression at third trimester (from 37.3 in 2002 to 80.9 in 2007-2008; p < 0.001). The co-formulation of zidovudine plus lamivudine remained the most common nucleoside backbone in pregnancy, even if a significant increase in the use of tenofovir plus emtricitabine was observed in more recent years. Starting from 2003, nevirapine prescription declined, paralleled by a significant rise in the use of protease inhibitors (PI), which were present in more than 60% of regimens administered in 2007-2008. Nelfinavir was progressively replaced by ritonavir-boosted PIs, mainly lopinavir. No significant changes in preterm delivery, Apgar score, birth weight, and birth defects were observed during the study period, and the rate of HIV transmission remained below 2%. These data demonstrate a significant evolution in the treatment of HIV in pregnancy. Constant improvements in the rates of HIV suppression were observed, probably driven by the adoption of stronger and more effective regimens and by the increasing options available for combination treatment.

Effect of Highly Active Antiretroviral Treatment (HAART) During Pregnancy on Pregnancy Outcomes: Experiences from a PMTCT Program in Western India

“…The association of preconception HAART and LBW among babies has been reported earlier for Botswana, 11,30,38 Brazil, 22 and Cote d'Ivoire. 9 In the study by Parekh et al 10 from Botswana which compared antenatal AZT with HAART, preconception HAART was associated with very-smallfor-gestational births but not with PB, whereas another study from the same country that assessed the effect of in utero exposure of HAART on longitudinal growth of uninfected children found significant LBW among infants exposed to HAART as compared to AZT-exposed infants.…”

“…11,23,36 This is the first study from India to demonstrate increased risk of preterm birth among children born to women receiving HAART during pregnancy. Average weeks at the time of delivery among women who received HAART was 37.74 (95% CI, 37.11-37.82) and 38.22 (95% CI, 38.06-38.39) among women who received AZT and very preterm births (between 28-32 weeks of pregnancy) was observed among 13 children, all but one were born to women who had received HAART.…”

“…While there is an increasing number of studies that suggest higher risk of preterm birth (PB) (< 37 weeks) [1][2][3][4][5][6][7] and low birth weight (LBW) 2,[8][9][10] among babies of women receiving HAART during pregnancy, there are also some studies that did not observe this association. [11][12][13][14][15][16] Most of the studies are from developed regions 4,[17][18][19] and only recently research findings are emerging from developing regions. 7,[20][21][22] Previous research from developed regions assessed the role of HAART containing protease inhibitors (PI), whereas the recent studies from developing regions have also evaluated the effect of PI excluded HAART on pregnancy outcomes (Table 1).…”

Postpartum Discontinuation of Antiretroviral Therapy and Risk of Maternal AIDS-Defining Events, Non-AIDS–Defining Events, and Mortality Among a Cohort of HIV-1–Infected Women in the United States

“…18 These studies showed that women discontinuing ART postpartum either had an increased risk of progression to ADE or death, 16 no difference in progression to ADE or death, 17 or increased risk of class B events. 18 HAART use in our cohort was similar to the use in another study in a resource-rich setting over comparable period of time 19 : PI-based HAART regimen use increased and NNRTIand NRTI-based HAART regimen use decreased during the study period.…”

Time to viral load suppression in antiretroviral‐naive and ‐experienced HIV‐infected pregnant women on highly active antiretroviral therapy: implications for pregnant women presenting late in gestation

“…Additionally, recent data show that an increasing proportion of pregnant women are ARV-experienced before pregnancy, though not more likely to actually be taking ARVs at the time of conception. 22 In light of the conflicting results of the few studies that have assessed differences in time to achieve viral load suppression in pregnant women who are ARV-naive versus ARVexperienced, further examination of potential confounders in the association between ARV exposure history and time to undetectable viral load during pregnancy is needed. 17,20,21 The potential difference in viral decay based on previous ARV exposure and the increasing proportion of ARV-experienced pregnant women justify further analysis of viral decay based on previous ARV exposure.…”