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Influence of short-course antenatal antiretroviral therapy on viral load and mother-to-child transmission in subsequent pregnancies among HIV-infected women.
Antivir Ther. 2013; 18(2):183-92.AT

Abstract

BACKGROUND

HIV-infected women not requiring treatment for their own health usually receive short-course antiretroviral therapy (ART) during pregnancy. Little is known about the effect of this on response to HAART in subsequent pregnancies.

METHODS

We analysed data from the UK and Ireland's National Study of HIV in Pregnancy and Childhood for 2000-2010. Analyses were restricted to live births among women not on ART at conception but receiving antenatal HAART. We compared risk of detectable viral load at delivery and mother-to-child transmission in two pregnancy groups: 'ART-naive' and 'HAART-experienced' (≥7 days of HAART during previous pregnancy). Multivariable analyses were conducted using logistic regression.

RESULTS

There were 5,372 pregnancies in the ART-naive group and 605 in the HAART-experienced group. Overall, there was weak evidence of an increased risk of detectable viral load in the HAART-experienced group (adjusted odds ratio [aOR] 1.27; 95% CI 1.01, 1.60); however, the increased risk was apparent only among women who previously received non-nucleoside reverse transcriptase inhibitor-based HAART (aOR 1.81; 95% CI 1.25, 2.63), and not among those with previous protease-inhibitor-based HAART exposure (aOR 1.08; 95% CI 0.81, 1.45). There was no difference in mother-to-child transmission risk between the ART-naive and HAART-experienced groups (aOR 0.42; 95% CI 0.10, 1.78), although the number of transmissions was small.

CONCLUSIONS

We found no increased risk of detectable viral load at delivery among women exposed to short-course, protease-inhibitor-based HAART during a previous pregnancy. However, women with prior exposure to non-nucleoside reverse transcriptase inhibitor-based HAART appeared to be at increased risk of not adequately suppressing the virus. These findings highlight the need for careful management of HIV-infected women presenting with repeat pregnancies.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

French CE
MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK. Clare.french.09@ucl.ac.uk
Tookey PA
No affiliation info available
Cortina-Borja M
No affiliation info available
de Ruiter A
No affiliation info available
Townsend CL
No affiliation info available
Thorne C
No affiliation info available

MeSH

AdultAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountDelivery, ObstetricFemaleHIV InfectionsHumansInfectious Disease Transmission, VerticalMiddle AgedPregnancyPregnancy Complications, InfectiousRiskTreatment OutcomeViral LoadYoung Adult

Pub Type(s)

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

Language

eng

PubMed ID

23475123

Citation

French, Clare E., et al. "Influence of Short-course Antenatal Antiretroviral Therapy On Viral Load and Mother-to-child Transmission in Subsequent Pregnancies Among HIV-infected Women." Antiviral Therapy, vol. 18, no. 2, 2013, pp. 183-92.
French CE, Tookey PA, Cortina-Borja M, et al. Influence of short-course antenatal antiretroviral therapy on viral load and mother-to-child transmission in subsequent pregnancies among HIV-infected women. Antivir Ther. 2013;18(2):183-92.
French, C. E., Tookey, P. A., Cortina-Borja, M., de Ruiter, A., Townsend, C. L., & Thorne, C. (2013). Influence of short-course antenatal antiretroviral therapy on viral load and mother-to-child transmission in subsequent pregnancies among HIV-infected women. Antiviral Therapy, 18(2), 183-92. https://doi.org/10.3851/IMP2327
French CE, et al. Influence of Short-course Antenatal Antiretroviral Therapy On Viral Load and Mother-to-child Transmission in Subsequent Pregnancies Among HIV-infected Women. Antivir Ther. 2013;18(2):183-92. PubMed PMID: 23475123.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of short-course antenatal antiretroviral therapy on viral load and mother-to-child transmission in subsequent pregnancies among HIV-infected women. AU - French,Clare E, AU - Tookey,Pat A, AU - Cortina-Borja,Mario, AU - de Ruiter,Annemiek, AU - Townsend,Claire L, AU - Thorne,Claire, Y1 - 2012/08/22/ PY - 2012/07/20/accepted PY - 2013/3/12/entrez PY - 2013/3/12/pubmed PY - 2013/9/14/medline SP - 183 EP - 92 JF - Antiviral therapy JO - Antivir Ther VL - 18 IS - 2 N2 - BACKGROUND: HIV-infected women not requiring treatment for their own health usually receive short-course antiretroviral therapy (ART) during pregnancy. Little is known about the effect of this on response to HAART in subsequent pregnancies. METHODS: We analysed data from the UK and Ireland's National Study of HIV in Pregnancy and Childhood for 2000-2010. Analyses were restricted to live births among women not on ART at conception but receiving antenatal HAART. We compared risk of detectable viral load at delivery and mother-to-child transmission in two pregnancy groups: 'ART-naive' and 'HAART-experienced' (≥7 days of HAART during previous pregnancy). Multivariable analyses were conducted using logistic regression. RESULTS: There were 5,372 pregnancies in the ART-naive group and 605 in the HAART-experienced group. Overall, there was weak evidence of an increased risk of detectable viral load in the HAART-experienced group (adjusted odds ratio [aOR] 1.27; 95% CI 1.01, 1.60); however, the increased risk was apparent only among women who previously received non-nucleoside reverse transcriptase inhibitor-based HAART (aOR 1.81; 95% CI 1.25, 2.63), and not among those with previous protease-inhibitor-based HAART exposure (aOR 1.08; 95% CI 0.81, 1.45). There was no difference in mother-to-child transmission risk between the ART-naive and HAART-experienced groups (aOR 0.42; 95% CI 0.10, 1.78), although the number of transmissions was small. CONCLUSIONS: We found no increased risk of detectable viral load at delivery among women exposed to short-course, protease-inhibitor-based HAART during a previous pregnancy. However, women with prior exposure to non-nucleoside reverse transcriptase inhibitor-based HAART appeared to be at increased risk of not adequately suppressing the virus. These findings highlight the need for careful management of HIV-infected women presenting with repeat pregnancies. SN - 2040-2058 UR - https://www.unboundmedicine.com/medline/citation/23475123/Influence_of_short_course_antenatal_antiretroviral_therapy_on_viral_load_and_mother_to_child_transmission_in_subsequent_pregnancies_among_HIV_infected_women_ L2 - http://www.diseaseinfosearch.org/result/9735 DB - PRIME DP - Unbound Medicine ER -