Improved Obstetric Outcomes and Few Maternal Toxicities Are Associated With Antiretroviral Therapy, Including Highly Active Antiretroviral Therapy During Pregnancy

Abstract

Data from 2543 HIV-infected women were analyzed to correlate antiretroviral therapy (ART) used during pregnancy with maternal and pregnancy outcomes. ART was analyzed according to class of agents used and according to monotherapy versus combination ART containing neither protease inhibitors (PIs) nor nonnucleoside reverse transcriptase inhibitors versus highly active ART. Timing of ART was classified according to early (recorded at or before 25-week gestation study visit) and late (recorded at 32-week gestation or delivery visit) use. Maternal outcomes assessed included hematologic, gastrointestinal, neurologic, renal, and dermatologic complications; gestational diabetes; lactic acidosis; and death. Adverse pregnancy outcomes assessed included hypertensive complications; pre-term labor or rupture of membranes; preterm delivery (PTD); low birth weight; and stillbirth. Logistic regression analyses controlling for multiple covariates revealed ART to be independently associated with few maternal complications: ART use was associated with anemia (odds ratio [OR] = 1.6, 95% confidence interval [CI]: 1.1-2.4), and late use of ART was associated with gestational diabetes (OR = 3.5, 95% CI: 1.2-10.1). Logistic regression analyses revealed an increase in PTD at <37 weeks for 10 women with late use of ART not containing zidovudine (ZDV; OR = 7.9, 95% CI: 1.4-44.6) and a decrease in adverse pregnancy outcomes as follows: late use of ART containing ZDV was associated with decreased risk for stillbirth and PTD at <37 weeks (OR = 0.06, 95% CI: 0.02-0.18; OR = 0.5, 95% CI: 0.3-0.8, respectively), and ART containing nucleoside reverse transcriptase inhibitors but not ZDV during early and late pregnancy was associated with decreased risk for PTD at <32 weeks (OR = 0.3, 95% CI: 0.2-0.7). Benefits of ART continue to outweigh observed risks.

Association between in utero zidovudine exposure and nondefect adverse birth outcomes: analysis of prospectively collected data from the Antiretroviral Pregnancy Registry

“…In studies that have examined the relationship between HAART or ZDV monotherapy use during pregnancy, HAART was associated with a higher risk of stillbirth 14, 20, 21. Tuomala et al.…”

Estratégias que reduzem a transmissão vertical do vírus da imunodeficiência humana tipo 1

“…Felizmente, as alterações mitocondriais são raras, mas o seu prognóstico é extremamente desfavorável. Dos efeitos fetais indesejáveis referentes ao uso dos inibidores da protease, os mais relatados são a prematuridade e a restrição de crescimento intra-útero 21,22 , mas existem discordâncias 23 . Recentemente, foi relatada também a ocorrência de insulinopenia neonatal em crianças nascidas de mães que utilizaram estes fármacos durante a gravidez 24 .…”

“…Dentre os efeitos colaterais maternos decorrentes do uso dos anti-retrovirais são citadas as alterações gastrointestinais, hepáticas, pancreá-ticas e anemia 21 . Adicionalmente, com o uso dos inibidores da protease observam-se as dislipidemias e as alterações sobre o metabolismo glicídico, tanto experimental quanto em gestantes, predispondo ao diabetes gestacional 25,26 .…”

“…Existe uma associação comercialmente disponível em comprimidos que contém 300 mg de AZT com 150 mg de 3TC, administrados duas vezes ao dia, facilitando a posologia. O NFV, utilizado na dose de 750 mg, administrado via oral, três vezes ao dia, é o mais utilizado entre os inibidores da protease, por apresentar menor nú-mero de efeitos colaterais durante a gravidez 21 . Os esquemas curtos de administração do AZT também têm demonstrado sua utilidade, principalmente em comunidades sem acesso ao esquema completo do AZT (pré-natal, parto e neonatal) 29 .…”

11.0 References

“…Several large studies from the USA have not found an association between HAART and PTD [90,91]. In two further studies, one multicentre study from the Pediatric Spectrum of HIV Disease cohort and one single-centre study, an association between PTD and HAART was found only if HAART included a PI [92,93].…”