Previous Antiretroviral Therapy for Prevention of Mother-to-Child Transmission of HIV Does not Hamper the Initial Response to PI-Based Multitherapy During Subsequent Pregnancy

Abstract

Efficacy of PI-based combinations is not decreased in women previously exposed to various regimens of antiretroviral PMTCT.

Is peripartum zidovudine absolutely necessary for patients with a viral load less than 1,000 copies/ml?

“…In terms of future use of HAART, effi cacy of PI-based combinations is also not decreased in women previously exposed to various regimens of antiretroviral for prevention of MTCT (Briand et al 2011).…”

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

“…This is different from findings of other investigators who reported that ARV exposure history was not associated with HIV virological response in pregnant women. 20,21 Additionally, while our study estimated only small differences in median time to viral suppression between ARVnaive and ARV-experienced women, Schalkwyk et al 17 who also performed this comparison found that it took, on average, 20 days longer for ARV-experienced women to achieve viral suppression. One may hypothesise that, given the frequent use of HIV genotype resistance assays in our cohort for the majority of ARV-experienced women (82%), they were prescribed fully suppressive regimens with at least three active antiretroviral medications and, therefore, would be expected to experience excellent virological outcomes.…”

“…15 Our investigation is one of the few published reports that compared ARV-naive and ARV-experienced pregnant women. 17,20,21 The results indicate a possible difference in time to achieve specified viral load threshold based on simple group comparisons of ARV-naive versus ARV-experienced women for <400 copies/ml (not statistically significant) and <1000 copies/ml (statistically significant). This is different from findings of other investigators who reported that ARV exposure history was not associated with HIV virological response in pregnant women.…”

“…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.…”

“…[8][9][10][11] Whereas HIV viral dynamics have been well described in non-pregnant cohorts, physiological and pharmacological changes in pregnancy may limit the generalisability of these studies to a pregnant population. [12][13][14] Few studies have examined virological response in HIV-infected pregnant women receiving HAART, [15][16][17][18][19][20][21] and many of these studies have included exclusively or predominantly ARVnaive cohorts. 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.…”