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Premature delivery in HIV-infected women starting protease inhibitor therapy during pregnancy: role of the ritonavir boost?
Clin Infect Dis. 2012 May; 54(9):1348-60.CI

Abstract

BACKGROUND

The association between combination antiretroviral (cARV) therapy use by human immunodeficiency virus (HIV)-infected women during pregnancy and risk of prematurity is still controversial. We explored this question, focusing on the initiation of ritonavir-boosted protease inhibitors (PIs) during pregnancy, which is now standard care.

METHODS

Trends in prematurity (<37 gestational weeks) were studied among all singleton pregnancies in the Agence Nationale de Recherche sur le SIDA (ANRS) French Perinatal Cohort from 1990 through 2009 (n = 13 271). In-depth analysis was conducted in a more detailed substudy of the cohort, among women starting PI-based ARV therapy during pregnancy (n = 1253). Multivariable analysis adjusted for immunovirological status and known risk factors for prematurity.

RESULTS

Prematurity increased from 9.2% during 1990-1993 (no therapy) and 9.6% during 1994-1996 (mostly zidovudine monotherapy) to 12.4% during 1997-1999 (dual-nucleoside analog therapy) and 14.3% during 2005-2009 (routine cARV therapy; P < .01). Prematurity was associated with cARV therapy, compared with zidovudine monotherapy, with an adjusted odds ratio of 1.69 (95% confidence interval [CI], 1.38-2.07; P < .01) when accounting for maternal age, intravenous drug use, geographic origin, and CD4 cell count. During 2005-2009, the prematurity rate was higher with boosted than with nonboosted PI therapy started during pregnancy (14.4% vs 9.1% [P = .05]; adjusted hazard ratio, 2.03 [95% CI, 1.06-3.89; P = .03] in multivariate analysis). The difference concerned mainly induced preterm delivery for maternal or fetal indications (5.6% vs 1.6%; P = .02),

CONCLUSIONS

The prematurity rate among HIV-infected pregnant women was twice that in the general population in France; this was not entirely explained by sociodemographic characteristics. Prematurity was independently associated with cARV therapy and, particularly, with the initiation of ritonavir-boosted PI therapy during pregnancy.

Authors+Show Affiliations

CESP INSERM U1018, Le Kremlin-Bicêtre, Colombes, France. jeannesibiude@yahoo.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22460969

Citation

Sibiude, Jeanne, et al. "Premature Delivery in HIV-infected Women Starting Protease Inhibitor Therapy During Pregnancy: Role of the Ritonavir Boost?" Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 54, no. 9, 2012, pp. 1348-60.
Sibiude J, Warszawski J, Tubiana R, et al. Premature delivery in HIV-infected women starting protease inhibitor therapy during pregnancy: role of the ritonavir boost? Clin Infect Dis. 2012;54(9):1348-60.
Sibiude, J., Warszawski, J., Tubiana, R., Dollfus, C., Faye, A., Rouzioux, C., Teglas, J. P., Ekoukou, D., Blanche, S., & Mandelbrot, L. (2012). Premature delivery in HIV-infected women starting protease inhibitor therapy during pregnancy: role of the ritonavir boost? Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 54(9), 1348-60. https://doi.org/10.1093/cid/cis198
Sibiude J, et al. Premature Delivery in HIV-infected Women Starting Protease Inhibitor Therapy During Pregnancy: Role of the Ritonavir Boost. Clin Infect Dis. 2012;54(9):1348-60. PubMed PMID: 22460969.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Premature delivery in HIV-infected women starting protease inhibitor therapy during pregnancy: role of the ritonavir boost? AU - Sibiude,Jeanne, AU - Warszawski,Josiane, AU - Tubiana,Roland, AU - Dollfus,Catherine, AU - Faye,Albert, AU - Rouzioux,Christine, AU - Teglas,Jean-Paul, AU - Ekoukou,Dieudonné, AU - Blanche,Stéphane, AU - Mandelbrot,Laurent, Y1 - 2012/03/28/ PY - 2012/3/31/entrez PY - 2012/3/31/pubmed PY - 2013/1/30/medline SP - 1348 EP - 60 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 54 IS - 9 N2 - BACKGROUND: The association between combination antiretroviral (cARV) therapy use by human immunodeficiency virus (HIV)-infected women during pregnancy and risk of prematurity is still controversial. We explored this question, focusing on the initiation of ritonavir-boosted protease inhibitors (PIs) during pregnancy, which is now standard care. METHODS: Trends in prematurity (<37 gestational weeks) were studied among all singleton pregnancies in the Agence Nationale de Recherche sur le SIDA (ANRS) French Perinatal Cohort from 1990 through 2009 (n = 13 271). In-depth analysis was conducted in a more detailed substudy of the cohort, among women starting PI-based ARV therapy during pregnancy (n = 1253). Multivariable analysis adjusted for immunovirological status and known risk factors for prematurity. RESULTS: Prematurity increased from 9.2% during 1990-1993 (no therapy) and 9.6% during 1994-1996 (mostly zidovudine monotherapy) to 12.4% during 1997-1999 (dual-nucleoside analog therapy) and 14.3% during 2005-2009 (routine cARV therapy; P < .01). Prematurity was associated with cARV therapy, compared with zidovudine monotherapy, with an adjusted odds ratio of 1.69 (95% confidence interval [CI], 1.38-2.07; P < .01) when accounting for maternal age, intravenous drug use, geographic origin, and CD4 cell count. During 2005-2009, the prematurity rate was higher with boosted than with nonboosted PI therapy started during pregnancy (14.4% vs 9.1% [P = .05]; adjusted hazard ratio, 2.03 [95% CI, 1.06-3.89; P = .03] in multivariate analysis). The difference concerned mainly induced preterm delivery for maternal or fetal indications (5.6% vs 1.6%; P = .02), CONCLUSIONS: The prematurity rate among HIV-infected pregnant women was twice that in the general population in France; this was not entirely explained by sociodemographic characteristics. Prematurity was independently associated with cARV therapy and, particularly, with the initiation of ritonavir-boosted PI therapy during pregnancy. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22460969/Premature_delivery_in_HIV_infected_women_starting_protease_inhibitor_therapy_during_pregnancy:_role_of_the_ritonavir_boost L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis198 DB - PRIME DP - Unbound Medicine ER -