Increased Risk of Preterm Delivery Among HIV-Infected Women Randomized to Protease Versus Nucleoside Reverse Transcriptase Inhibitor-Based HAART During Pregnancy

Powis, Kathleen M.; Kitch, Douglas; Ogwu, Anthony; Hughes, Michael D.; Lockman, Shahin; Leidner, Jean; Widenfelt, Erik van; Moffat, Claire; Moyo, Sikhulile; Makhema, Joseph; Essex, Max; Shapiro, Roger

doi:10.1093/infdis/jir307

Cited by 182 publications

(109 citation statements)

References 22 publications

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“…A study by the Agence Nationale de Recherche sur le Sida (ANRS) of France showed an increased rate of PTB among women treated with boosted versus unboosted PI (aHR 2.03, 95% CI 1.06–3.89), more specifically with respect to spontaneous delivery [25]. Our PTB rate of 19.3% among women treated with boosted PIs is also similar to that found in the Mma Bana study (21.4%) from Botswana, where all women in the PI treated arm received LPV-r during pregnancy [26]. In light of previous conflicting reports between North American and European cohorts, the concordance of our findings to the French perinatal cohort is reassuring.…”

Section: Discussionsupporting

confidence: 64%

Risk factors for pre‐term birth in a Canadian cohort of HIV‐positive women: role of ritonavir boosting?

Kakkar

Boucoiran

Lamarre

et al. 2015

Journal of the International AIDS Society

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BackgroundThe risk of pre-term birth (PTB) associated with the use of protease inhibitors (PIs) during pregnancy remains a subject of debate. Recent data suggest that ritonavir boosting of PIs may play a specific role in the initiation of PTB, through an effect on the maternal–fetal adrenal axis. The primary objective of this study is to compare the risk of PTB among women treated with boosted PI versus non-boosted PIs during pregnancy.MethodsBetween 1988 and 2011, 705 HIV-positive women were enrolled into the Centre Maternel et Infantile sur le SIDA mother–infant cohort at Centre Hospitalier Universitaire Sainte-Justine in Montreal, Canada. Inclusion criteria for the study were: 1) attendance at a minimum of two antenatal obstetric visits and 2) singleton live birth, at 24 weeks gestational or older. The association between PTB (defined as delivery at <37 weeks gestational age), antiretroviral drug exposure and maternal risk factors was assessed retrospectively using logistic regression.ResultsA total of 525 mother–infant pairs were included in the analysis. Among them, PI-based combination anti-retroviral therapy was used in 37.4%, boosted PI based in 24.4%, non-nucleoside reverse transcriptase inhibitor (NNRTI) or nucleoside reverse transcriptase inhibitor based in 28.1%, and no treatment was given in 10.0% of cases. Overall, 13.5% of women experienced PTB. Among women treated with antiretroviral therapy, the risk of PTB was significantly higher among women who received boosted versus non-boosted PI (OR 2.01, 95% CI 1.02–3.97). This remained significant after adjusting for maternal age, delivery CD4 count, hepatitis C co-infection, history of previous PTB, and parity (aOR 2.17, 95% CI 1.05–4.51). There was no increased risk of PTB with the use of unboosted PIs as compared to NNRTI- or NRTI-based regimens.ConclusionWhile previous studies on the association between PTB and PI use have generally considered all PIs the same, our results would indicate a possible role of ritonavir boosting as a risk factor for PTB. Further work is needed to understand the pathophysiologic mechanisms involved, and to identify the safest ARV regimens to be used in pregnancy.

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Section: Discussionsupporting

confidence: 64%

Risk factors for pre‐term birth in a Canadian cohort of HIV‐positive women: role of ritonavir boosting?

Kakkar

Boucoiran

Lamarre

et al. 2015

Journal of the International AIDS Society

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“…Advanced maternal HIV disease is recognized as risk factor for LBW and PD according to the report of many studies [15,31,32]. Studies from Kenya also showed that HIV-infected women were 3 times more likely to deliver a LBW baby in the presence of HIV-related symptoms and lower CD4 level [33,34].…”

Section: Discussionmentioning

confidence: 99%

Birth outcome and correlates of low birth weight and preterm delivery among infants born to HIV-infected women in public hospitals of Northwest Ethiopia

Kebede¹,

Andargie²,

Gebeyehu³

2013

Health

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“…Sensitivity analyses were conducted to adjust for prematurity 35 and low birth weight. Since these birth characteristics could be on the causal pathway between in utero ARV exposure and later cognitive or academic functioning, they were not considered in the primary analyses.…”

Section: Methodsmentioning

confidence: 99%

Safety of In Utero and Neonatal Antiretroviral Exposure

Nozyce

Huo

Williams

et al. 2014

Pediatric Infectious Disease Journal

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Support The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard University School of Public Health (HD052102, 3 U01 HD052102-05S1, 3 U01 HD052102-06S3) and the Tulane University School of Medicine (HD052104, 3U01HD052104-06S1). Note: The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or U.S. Department of Health and Human Services.

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Increased Risk of Preterm Delivery Among HIV-Infected Women Randomized to Protease Versus Nucleoside Reverse Transcriptase Inhibitor-Based HAART During Pregnancy

Abstract: PI-based HAART was associated with increased preterm delivery but not increased infant hospitalizations or mortality in a clinical trial setting. The association between PI use and lower increase in BMI in late pregnancy warrants further study.

Cited by 182 publications

References 22 publications

Risk factors for pre‐term birth in a Canadian cohort of HIV‐positive women: role of ritonavir boosting?

Risk factors for pre‐term birth in a Canadian cohort of HIV‐positive women: role of ritonavir boosting?

Birth outcome and correlates of low birth weight and preterm delivery among infants born to HIV-infected women in public hospitals of Northwest Ethiopia

Safety of In Utero and Neonatal Antiretroviral Exposure

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