Pregnancy Outcome in Women Infected With HIV-1 Receiving Combination Antiretroviral Therapy Before Versus After Conception
E.S. Machado; C.B. Hofer; T.T. Costa; S.A. Nogueira; R.H. Oliveira; T.F. Abreu; L.A. Evangelista; I.F.A. Farias; R.T.C. Mercadante; M.F.L. Garcia; R.C. Neves; V.M. Costa; J.S. Lambert
E.S. Machado; C.B. Hofer; T.T. Costa; S.A. Nogueira; R.H. Oliveira; T.F. Abreu; L.A. Evangelista; I.F.A. Farias; R.T.C. Mercadante; M.F.L. Garcia; R.C. Neves; V.M. Costa; J.S. Lambert
Abstract
Objective: The potential adverse effects of antiretroviral drugs during pregnancy are discrepant and few studies, mostly from Europe, have provided information about pregnancy outcomes of those already on treatment at conception. The aim of this study was to investigate the impact of antiretrovirals (ARVs) on pregnancy outcome according to the timing of treatment initiation in a cohort of pregnant women from Brazil infected with HIV.
Methods: A prospective cohort of 696 pregnant women followed up in one single centre between 1996 and 2006 was studied. Patients who had ARV treatment before pregnancy were compared with those treated after the first trimester. The outcomes evaluated were preterm delivery (under 37 weeks), severe preterm delivery (under 34 weeks), low birth weight(under 2500 g) and very low birth weight (under 1500 g).
Objective: The potential adverse effects of antiretroviral drugs during pregnancy are discrepant and few studies, mostly from Europe, have provided information about pregnancy outcomes of those already on treatment at conception. The aim of this study was to investigate the impact of antiretrovirals (ARVs) on pregnancy outcome according to the timing of treatment initiation in a cohort of pregnant women from Brazil infected with HIV.
Methods: A prospective cohort of 696 pregnant women followed up in one single centre between 1996 and 2006 was studied. Patients who had ARV treatment before pregnancy were compared with those treated after the first trimester. The outcomes evaluated were preterm delivery (under 37 weeks), severe preterm delivery (under 34 weeks), low birth weight(under 2500 g) and very low birth weight (under 1500 g).
Results: Patients who were using ARVs pre-conception had higher rates of LBW (33.3% vs 16.5%) and a similar trend for PTD (26.3% vs 17.7%). Stratification by type of therapy (dual vs highly active antiretroviral therapy (HAART)) according to timing of initiation of ARVs showed that patients who use HAART pre-conception have a higher rate of PTD (20.2% vs 10.2%) and LBW (24.2% vs 10.2%). After adjusting for several factors, HAART used pre-conception was associated with an increased risk for PTD and LBW.
Conclusions: We identified an increased risk for LBW and PTD in patients who had HAART prior to pregnancy.
Introduction
Over the last decade, treatment for the prevention of mother to child transmission (MTCT) of HIV has moved from zidovudine (AZT) monotherapy to the use of highly active antiretroviral therapy (HAART) resulting in transmission rates of 1-2%. In Brazil, vertical transmission of HIV-1 has been responsible for almost 11 000 cases of AIDS in children younger than 13 years between 1996 and 2005; however, less than 350 cases were notified during the year of 2006.
Discrepant results on the risk of adverse pregnancy outcomes in women infected with HIV treated with HAART have been reported. European studies have shown that exposure to any combination therapy increases the risk of premature delivery (PTD), with the use of protease inhibitors being the highest risk, and also an increased risk for low birth weight (LBW) and stillbirths. In contrast with these findings, several studies in the USA and Latin America failed to show a higher risk of adverse outcomes, although a report from one single site in the USA showed a correlation between PTD and protease inhibitor use.
The impact of antiretroviral (ARV) drugs administered prior to conception has not been fully explored. The European Collaborative Study found a twofold increased risk of premature delivery and a fourfold increased risk for severe premature delivery in women who started combination therapy pre-conception. More recently, a 3.4-fold in the risk of PTD in patients treated with HAART was seen in a German/Austrian cohort where 52% of the patients were already being treated with HAART at conception.
There has been an increase in pregnant women who are HIV positive receiving antenatal therapy. This might be an effect of the increasing age in the population of pregnant women with HIV, repeated pregnancies or changes in CD4 threshold for starting treatment in patients infected with HIV. The aim of this study was to investigate the impact of ARVs on preterm delivery and LBW according to the timing of the initiation of the therapy in pregnancy.
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Conclusions: We identified an increased risk for LBW and PTD in patients who had HAART prior to pregnancy.
Introduction
Over the last decade, treatment for the prevention of mother to child transmission (MTCT) of HIV has moved from zidovudine (AZT) monotherapy to the use of highly active antiretroviral therapy (HAART) resulting in transmission rates of 1-2%. In Brazil, vertical transmission of HIV-1 has been responsible for almost 11 000 cases of AIDS in children younger than 13 years between 1996 and 2005; however, less than 350 cases were notified during the year of 2006.
Discrepant results on the risk of adverse pregnancy outcomes in women infected with HIV treated with HAART have been reported. European studies have shown that exposure to any combination therapy increases the risk of premature delivery (PTD), with the use of protease inhibitors being the highest risk, and also an increased risk for low birth weight (LBW) and stillbirths. In contrast with these findings, several studies in the USA and Latin America failed to show a higher risk of adverse outcomes, although a report from one single site in the USA showed a correlation between PTD and protease inhibitor use.
The impact of antiretroviral (ARV) drugs administered prior to conception has not been fully explored. The European Collaborative Study found a twofold increased risk of premature delivery and a fourfold increased risk for severe premature delivery in women who started combination therapy pre-conception. More recently, a 3.4-fold in the risk of PTD in patients treated with HAART was seen in a German/Austrian cohort where 52% of the patients were already being treated with HAART at conception.
There has been an increase in pregnant women who are HIV positive receiving antenatal therapy. This might be an effect of the increasing age in the population of pregnant women with HIV, repeated pregnancies or changes in CD4 threshold for starting treatment in patients infected with HIV. The aim of this study was to investigate the impact of ARVs on preterm delivery and LBW according to the timing of the initiation of the therapy in pregnancy.
DOWNLOAD COMPLETE PDF HERE
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