Multicenter Review of Protease Inhibitors in 89 Pregnancies

Morris, Anne B.; Cu‐Uvin, Susan; Harwell, Joseph I.; Garb, Jane; Zorrilla, Carmen; Vajaranant, Mark; Dobles, Ana Rua; Jones, Theodore B.; Carlan, S. J.; Allen, Diane Y.

doi:10.1097/00126334-200012010-00003

Cited by 43 publications

(30 citation statements)

References 8 publications

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“…The preterm delivery rate at the UM/JMMC is higher than that at other centers; however, after having considered all possible confounders, the present results appear to be real and to confirm reports from the European/Swiss cohort that ART during pregnancy, especially when it includes PIs, may increase the risk of preterm delivery [5]. The preterm delivery rate from that study of 29% in women receiving combination therapy with PIs was higher than the 19% rate reported in a review of 89 PI-exposed pregnancies in the United States [10], but it is closer to the rates in the present study. There was no significant increase in a rate of preterm delivery at р32 weeks in women receiving combination therapy with a PI, possibly because of a decreased exposure time to the PI.…”

Section: Discussionsupporting

confidence: 86%

Is Antiretroviral Therapy during Pregnancy Associated with an Increased Risk of Preterm Delivery, Low Birth Weight, or Stillbirth?

et al. 2006

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Background. Data on complications of pregnancy associated with antiretroviral therapy are limited. Some small studies have demonstrated an increased preterm delivery rate, but a recent retrospective United States multisite study did not concur with these findings. Our objective was to investigate whether antiretroviral therapy was associated with adverse pregnancy outcome at a single site.Methods. Using prospectively gathered data, women were identified who were determined to be human immunodeficiency virus positive before or during pregnancy who sought care at our prenatal clinic and who gave birth at the University of Miami/Jackson Memorial Medical Center from 1990 through 2002. The outcome measures were preterm delivery, low birth weight, and stillbirth.Results. The cohort included 999 women who received antiretroviral therapy during pregnancy (monotherapy in 492, combination therapy without a protease inhibitor [PI] in 373, and combination therapy with a PI in 134) and 338 women who did not receive therapy. After adjustment for possible confounders, only combination therapy with a PI was associated with an increased risk of preterm delivery, compared with any other combination (odds ratio, 1.8 [95% confidence interval, 1.1-3.0]). There were no differences in rates of low birth weight and stillbirth, regardless of therapy.Conclusion. Compared with monotherapy and combination therapy without a PI, only combination therapy with a PI was associated with an increased risk of preterm delivery.

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Section: Discussionsupporting

confidence: 86%

Is Antiretroviral Therapy during Pregnancy Associated with an Increased Risk of Preterm Delivery, Low Birth Weight, or Stillbirth?

et al. 2006

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“…In therapy-naive women, HAART was usually started at 24-28 weeks; in case of CD4+ count <200 cells/mm 3 HAART was started as soon as possible. Women on therapy were sometimes switched to more favourable combinations.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4] In the Netherlands, consensus on HAART treatment during pregnancy was reached in 2001, 5 but in the largest HIV centres, this policy was already instituted at the end of 1997.…”

Section: Introductionmentioning

confidence: 99%

The AmRo study: pregnancy outcome in HIV‐1‐infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

Boer¹,

Nellen

Patel

et al. 2007

BJOG

117

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Objective To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART).Design Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n = 98).Setting Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands.Population Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women.Main outcome measures MTCT, preterm delivery, low birthweight, pre-eclampsia.Results MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P = 0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls.Conclusions We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAARTassociated increase in preterm delivery rate is mainly seen after first trimester HAART use.

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“…PIs within highly active antiretroviral therapy are used increasingly in pregnancy due to their potency (21,24,26); however, there are limited data on placental transfer of these drugs. Previous studies with isolated perfused human placentae demonstrated low maternal-to-fetal transfer of amprenavir, ritonavir, and saquinavir (4,6,11).…”

mentioning

confidence: 99%

Differential Bidirectional Transfer of Indinavir in the Isolated Perfused Human Placenta

Sudhakaran

Ghabrial

Nation

et al. 2005

Antimicrob Agents Chemother

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Multicenter Review of Protease Inhibitors in 89 Pregnancies

Cited by 43 publications

References 8 publications

Is Antiretroviral Therapy during Pregnancy Associated with an Increased Risk of Preterm Delivery, Low Birth Weight, or Stillbirth?

Is Antiretroviral Therapy during Pregnancy Associated with an Increased Risk of Preterm Delivery, Low Birth Weight, or Stillbirth?

The AmRo study: pregnancy outcome in HIV‐1‐infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

Differential Bidirectional Transfer of Indinavir in the Isolated Perfused Human Placenta

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