British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018

Gilleece, Yvonne; Tariq, Shema; Bamford, Alasdair; Bhagani, Sanjay; Byrne, Laura; Clarke, Emily; Clayden, Polly; Lyall, Hermione; Metcalfe, Rebecca; Palfreeman, Adrian; Rubinstein, Luciana; Sonecha, S; Thorley, Lisa; Tookey, P; Tosswill, Jennifer; Utting, David; Welch, S; Wright, Alison

doi:10.1111/hiv.12720

Cited by 52 publications

(120 citation statements)

References 339 publications

(377 reference statements)

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…RAL has been the most frequently used INI, with demonstrated utility in patients with late diagnosis in pregnancy due to its good placental transfer, as well as in pregnant women with resistant viruses to first-line drugs [2][3][4][5]10,11], being currently the preferred INI in pregnancy [3].…”

Section: Methodsmentioning

confidence: 99%

“…This drug has also increasingly been used and effectively as intensification of AT in pregnant women with bad control of infection in late stages of pregnancy [3,[5][6][7]10,11]. In addition, its inclusion in treatment guidelines as elective therapy in adults and since a high proportion of pregnancys are unplanned, an increase in use of INIs in pregnant women may be anticipated.…”

Section: Methodsmentioning

confidence: 99%

“…The difficulty to achieve an undetectable VL before delivery in those pregnant women with late diagnosis or poor control of the infection with antiretroviral regimens used so far in pregnancy [2 nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs) plus 1 protease inhibitor (PI) or 1 non-nucleoside reverse transcriptase inhibitor (NNRTIs)], has led to the increasing use of regimens that include drugs from the family of integrase inhibitors (INIs) in risky situations [4,9,10]. They are characterized by their effectiveness to achieve a rapid VL decrease.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort

Ramos

Mazariegos

Beceiro

et al. 2019

Preprint

View full text Add to dashboard Cite

Background The risk of HIV-1 mother-to-child transmission (MTCT) is associated mainly with the gestational age at which antiretroviral therapy (AT) begins and HIV-1-RNA viral load (VL) at delivery. The importance of achieving virological supression during pregnancy, has led to an increased use of integrase inhibitors (INIs) in risky conditions. Our objective was to assess the safety and effectiveness in Madrid-Cohort of mothers-children exposed to INIs during pregnancy. Methods Retrospective, multicentric, observational, cohort study, of HIV-1-infected pregnant women exposed to INIs during pregnancy and their infants, from 2000 to 2017, from the nine public hospitals belonging to the Madrid Cohort. Maternal demographic characteristics, clinical data, HIV-1 infection features, AT regimens and changes of treatment during pregnancy were recorded. Blood count, biochemistry panel, HIV-1 VL and CD4+ lymphocyte counts/percentage at first trimester and at the last one near delivery were also collected. Results Sixty seven pregnant women exposed to INIs from the Madrid cohort (n: 1423) and their 68 children were identified (17.6% premature). Neonatal prophylaxis consited mostly on zidovudine (AZT) monotherapy, followed by combined prophylaxis with ‘triple therapy’. There were no cases of MTCT. Twenty women were diagnosed with HIV-1 in the current pregnancy. Of 43 women with AT before pregnancy, 65% received INI before conception. Raltegravir was the most commonly used (80.5%). The median lenght with INI at delivery was 148 days [interquartile rang (IR): 29-251]. Median CD4+ lymphocyte count increased from 428 cells/mL (IR: 310-642) in first trimester to 636 cells/mL (IR: 408-818) in the third. There was a statistically significant increase (p=0.02) of mothers with undetectable VL at delivery compared with first trimester. INIs were well tolerated, without any relevant adverse effect notification. There was no case of discontinued medication due to intolerance or toxicity. 11,7% of children had minor birth defects and one patient had ventricular septal defect without hemodynamic compromise. All of them evolved favourably. Conclusions INI seems safe and effective in prevention of MTCT. Antiretroviral regimens during pregnancy that include INI are increasingly being used. Our findings support the use of INI as intensification in pregnant women at high risk of MTCT.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort

Ramos

Mazariegos

Beceiro

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Do not return to breastfeeding once the baby starts formula feeding [11]. 10 Get breastfeeding advice from someone who knows you are living with HIVthe advice is sometimes different for women living with HIV than those without HIV [17,35,36].…”

Section: The Futurementioning

confidence: 99%

Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high‐income countries

Freeman-Romilly

Nyatsanza

Namiba³

et al. 2019

HIV Medicine

View full text Add to dashboard Cite

“…Guidance regarding the timing of cART initiation and the class of compounds used during pregnancy has evolved over the study period and continue to vary between guidelines (6)(7)(8)(9). British HIV Association (BHIVA) guidelines recommend that if maternal plasma viral load (pVL) is >100,000 copies/mL and/or CD4+ count is <200 cells/µL, cART should be initiated within the rst trimester, and that all women should have commenced cART by 24 weeks' gestation (10). Women presenting with untreated HIV beyond 28 weeks' gestation should initiate cART immediately, and if pVL is >100,000 copies/mL, a three-or four-drug regimen including raltegravir or dolutegravir is recommended.…”

Section: Introductionmentioning

confidence: 99%

An observational study of initial HIV RNA decay following initiation of combination antiretroviral treatment during pregnancy

Alagaratnam¹,

Peters²,

Francis³

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background In pregnancy, reduction of HIV plasma viral load (pVL) for the prevention of vertical transmission is time-constrained. The study primary objective is to investigate factors associated with faster initial HIV RNA half-life decay when combination antiretroviral treatment (cART) is initiated in pregnancy.Methods This was a multicentre, retrospective, observational study, conducted in south England, United Kingdom, between August 2001 and February 2018. Data were extracted from case notes of eligible women initiating cART during the index pregnancy. Anonymised data were collated and analysed centrally. Regression analyses were conducted to determine factors associated with faster HIV RNA half-life decay in the first 14 days after commencing cART (first-phase), and with achieving an undetectable maternal pVL by 36 weeks’ gestation. We then assessed whether HIV- and obstetric- related parameters differed by antiretroviral third agent class and whether the proportions of women with undetectable pVL at 36 weeks’ gestation and at delivery differed by antiretroviral third agent class.Results Baseline pVL was the only independent factor associated with faster first-phase HIV RNA half-life decay on commencing cART. Lower pVL on day 14 after starting cART was associated with an increased likelihood of achieving an undetectable pVL by 36 weeks’ gestation. Integrase inhibitor-based cART was associated with a faster first-phase HIV RNA half-life decay on commencing cART. Overall, 73% and 85% of women had an undetectable pVL at 36 weeks’ gestation and at delivery respectively, with no significant difference by antiretroviral third agent class. Conclusions Only high baseline pVL independently contributed to a faster rate of first-phase viral half-life decay. pVL at 14 days after initiating cART allows early identification of treatment failure. In the first 14 days after initiating cART in pregnancy, integrase inhibitor-based cART reduced maternal pVL faster than protease inhibitor- and non-nucleoside reverse transcriptase-based cART. While our study findings support INSTI use when initiated in pregnancy especially when initiated at later gestations and in those with higher baseline pVL, other non-INSTI based cART with more data on safety in pregnancy also performed well.Trial registrationNot required.

show abstract

British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018

Cited by 52 publications

References 339 publications

Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort

Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort

Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high‐income countries

An observational study of initial HIV RNA decay following initiation of combination antiretroviral treatment during pregnancy

Contact Info

Product

Resources

About