Trends in antiretroviral use in pregnancy in the UK and Ireland, 2008–2018

Abstract

Introduction HIV treatment recommendations have evolved over time, reflecting both growing availability of new antiretrovirals and accumulating evidence on their safe and effective use. We analysed patterns of antiretroviral use among diagnosed pregnant women living with HIV delivering in the UK and Ireland between 2008 and 2018 using national surveillance data. Methods All singleton pregnancies with known outcomes and known timing of antiretroviral initiation reported to the National Surveillance of HIV in Pregnancy and Childhood were included. Every individual instance of specific antiretroviral use was the unit of analysis in generating a snapshot of antiretroviral use overall and over calendar time. The final analysis was restricted to the 14 most frequently prescribed antiretrovirals. Results There were 12 099 singleton pregnancies reported during 2008–2018 and a total of 38 214 individual uses of the 14 most commonly prescribed antiretrovirals, the majority of which were started before conception (70.9%). In 2008, 37.7% (482/1279) of pregnancies were conceived under treatment, reaching 80.9% (509/629) by 2018. Patterns of antiretroviral use have changed over time, particularly for third agents. Between 2008 and 2018 the most frequently used protease inhibitor shifted from lopinavir to darunavir, whereas use of integrase inhibitors increased steadily over time. Conclusions These national surveillance data enable investigation of the ‘real‐world’ use of antiretrovirals in pregnancy on a population level. Findings demonstrate mixed responsiveness of antiretroviral prescription to changes in pregnancy guideline recommendations and may also reflect changes in commissioning and in the characteristics of pregnant women living with HIV.

Inhibition of matrix metalloproteinases by HIV-1 integrase strand transfer inhibitors

“…In 2020, eighty five percent of HIV-1-infected pregnant women were on ART ( The Joint United Nations Programme on HIV/AIDS (UNAIDS), 2021a ). Due to such broad usage of ART during pregnancy, the rate of vertical transmission of HIV-1 has reduced to less than 1% ( The Centers for Disease Control and Prevention (CDC), 2018 ; Peters et al, 2017 ; Schnoll et al, 2019 ; Rasi et al, 2022 ; The Joint United Nations Programme on HIV/AIDS (UNAIDS), 2021b ). This includes resource-limited countries (RLCs), which currently hold up to two-thirds of the world’s total HIV-1 infected population ( The Joint United Nations Programme on HIV/AIDS (UNAIDS), 2021b ).…”

Gestational diabetes in women living with HIV in the UK and Ireland: insights from population‐based surveillance data

“…Integrated Screening Outcomes Surveillance Service (ISOSS) is commissioned by NHS England as part of the NHS Infectious Diseases in Pregnancy Screening Programme to conduct comprehensive population‐based active surveillance of all pregnancies to diagnosed WLWH in the UK and Ireland since 1989 (formerly the National Study of HIV in Pregnancy and Childhood) [ 10 ]. Data from Ireland are included until 2018, and Scotland, Wales and Northern Ireland included until 2019 [ 6 ].…”

“…Guidelines for HIV management, including in pregnancy, have evolved over time alongside the development of new antiretroviral drugs and classes, influencing both the timing of treatment initiation and drugs used in pregnancy [ 8 ]. Since 2015 and the onset of the universal treatment era, women have increasingly been on treatment prior to conception [ 9 ]; for example, in the UK, 81% of pregnancies were conceived on antiretroviral therapy (ART) in 2018 [ 10 ]. Furthermore, there have been changes in the characteristics of pregnant WLWH, including increasing maternal age, a growing number with vertically acquired HIV and a decreasing proportion born in sub‐Saharan Africa [ 11 , 12 ].…”

“…Since 2015 and the onset of the universal treatment era, women have increasingly been on treatment prior to conception [ 9 ]; for example, in the UK, 81% of pregnancies were conceived on antiretroviral therapy (ART) in 2018 [ 10 ]. Furthermore, there have been changes in the characteristics of pregnant WLWH, including increasing maternal age, a growing number with vertically acquired HIV and a decreasing proportion born in sub‐Saharan Africa [ 11 , 12 ]. The implications of lifelong treatment for non‐pregnant populations may include increased risk of diabetes [ 13 , 14 ] and cardiovascular disease [ 15 , 16 ], but findings on the effect of treatment in pregnancy, particularly protease inhibitors (PIs), on GD risk have been inconsistent [ 17 , 18 , 19 , 20 ].…”

Real‐world experience with weight gain among pregnant women living with HIV who are using integrase inhibitors

“…Real‐world studies can reveal whether trial findings still apply in settings in which the window for study visits is more flexible or to pregnant women living with HIV who would not have met the eligibility requirements for the P1081 and 2010 trials, such as ART‐experienced pregnant women. As of 2020, approximately 1.3 million pregnant women were living with HIV around the world [11], and an increasing percentage of pregnant women living with HIV are conceiving while using INSTIs [12]. Thus, it is worthwhile to investigate weight change among pregnant women living with HIV, including those who are treatment‐experienced, in a real‐world study.…”