Combination antiretroviral therapy with protease inhibitors in HIV-infected pregnancy

Dola, Chi; Khan, Rubina; DeNicola, Nathaniel; Amirgholami, Mahin; Benjamin, Tara; Bhuiyan, Azad R.; Longo, Sherri

doi:10.1515/jpm.2011.111

Cited by 11 publications

(10 citation statements)

References 13 publications

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“…The rate of LBW from our findings (<20%) differ considerably from data reported in Cote d’Ivoire and in India [ 8 , 11 , 12 ], possibly due to higher immunological status among women in our study. In the frame of findings from in Botswana and other African or Latin America settings, immune-compromised pregnant women receiving PMTCT option B+ should thus far be monitored during routine ANC to limit the potentials of foetal growth retardation in RLS [ 14 , 19 , 20 ], in order to achieve similar target performance in the western world [ 21 , 22 ].…”

Section: Discussioncontrasting

confidence: 99%

“…Interestingly, monotherapy (i.e. option A) and cART (option B or B+) used during pregnancy in SSA mostly consist of reverse transcriptase inhibitors, which are drugs with lesser antenatal impairments, compared to protease inhibitor-based regimens commonly used in developed countries [ 11 ]. Thus, understanding the impact of commonly used antiretrovirals on birth outcomes in SSA would serve in designing interventions aiming at: (a) continuing current ART during pregnancy without further interventions, (b) continuing current ART during with specific monitoring measures, or (c) switching from current ART to potential regimens with safer birth outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

et al. 2016

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BackgroundEffects of antiretroviral therapy (ART) on birth outcomes remain controversial.ObjectiveTo assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW).MethodsA cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (<37 weeks) and LBW (<2,500g) were analyzed using univariate and multivariate logistic regression; with p<0.05 considered statistically significant.ResultsOf the 760 infants, 481 were born from cART-exposed mothers against 279 from maternal-ZDV. Median maternal CD4 count was 378 [interquartile range (IQR): 253–535] cells/mm3. Median duration of ART at onset of delivery was 13 [IQR: 10–17] weeks. In the cART-group, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens. Events of PTB were not significantly higher in the cART-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of LBW were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05). Other factors (parity, maternal age at delivery or CD4 cell count) were not associated with PTB.ConclusioncART, initiated during pregnancy, would be an independent factor of LBW. In the era of option B+ (lifelong ART to all HIV-pregnant women), further studies would guide towards measures limiting onsets of LBW.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

et al. 2016

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“…[ 45 ] For example, two papers reported that preterm birth rates were similar to those found in a HIV negative population. [ 46 , 47 ] One study argued ART by itself may not be sufficient for decreasing the burden of adverse birth outcomes in HIV positive women without nutritional care. [ 33 ] The potential harm to the fetus from maternal ingestion of a drug not only depends on the drug itself, but on the dose, the gestational age at exposure, the duration of exposure, the interaction with other agents, and to an unknown extent, the genetic makeup of the mother and fetus.…”

Section: Discussionmentioning

confidence: 99%

Anti-retroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

et al. 2014

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Background:Despite significant efforts to understand adverse pregnancy outcome in women receiving Antiretroviral Therapy (ART), ART-related adverse birth outcomes are still poorly understood. We systematically review ART-related adverse birth outcomes among HIV-infected pregnant women; we also review the covariates associated with adverse birth outcomes in the aforementioned group.Methods:The main source for our systematic review was electronic bibliographic databases. Databases such as MEDLINE, PubMed, EMBASE and AIDSLINE were searched. Furthermore, search engines such as Google and Google Scholar were specifically searched for gray literature. Methodological quality of available literature was assessed using the Newcastle - Ottawa Quality Assessment Scale & M. Hewitt guideline. We examined a total of 1,124 papers and reviewed the studies using the PICOT criteria which stands for Patient (population), Intervention (or “Exposure”), Comparison, Outcome and Type of study. Finally, 32 methodologically fit studies were retained and included in our review.Results:Frequently observed adverse birth outcomes included low birth weight (LBW), Preterm Birth (PB), Small for Gestational Age (SGA), while still birth and congenital anomalies were infrequent. Type of regimen such as Protease Inhibitor (PI) based regimens and timing of initiation of ART are some of the factors associated with adverse pregnancy outcomes. Covariates principally included malnutrition and other co-morbidities such as malaria and HIV.Conclusions and Public Health Implications:There is growing evidence in published literature suggesting that ART might be causing adverse birth outcomes among pregnant women in developing countries. There is a need to consider regimen types for HIV-infected pregnant women. There is need to design large cohort studies.

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“…None of these studies implicated PIs directly, and more specific studies have reported no association between PI-based regimens and SGA 40,54,55. Likewise, the randomized Kesho Bora trial showed no significant increase in low (<2,500 g) or very low (<1,500 g) birth weights in the PI-based HAART arm 6.…”

Section: Pregnancy Outcomesmentioning

confidence: 99%

Safety of protease inhibitors in HIV-infected pregnant women

Chougrani

Luton²,

Matheron³

et al. 2013

HIV

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The dire conditions of the human immunodeficiency virus/acquired immune deficiency syndrome epidemic and the immense benefits of antiretroviral prophylaxis in prevention of mother-to-child transmission far outweigh the potential for adverse effects and undeniably justify the rapid and widespread use of this therapy, despite incomplete safety data. Highly active antiretroviral therapy has now become standard care, and more than half the validated regimens include protease inhibitors. This paper reviews current knowledge of the safety of these drugs during pregnancy, in terms of maternal and fetal outcomes. Transfer of protease inhibitors across the placenta is known to be minimal, and current data about birth defects and fetal malignancies are reassuring. Maternal liver function and glucose metabolism should be monitored in women treated with protease inhibitor-based regimens, but concerns about the development of maternal resistance, should treatment be discontinued, have been shown to be groundless. Neonates should be screened for hematologic abnormalities, although these are rarely severe or permanent and are not usually related to the protease inhibitor component of the antiretroviral combination. Current findings concerning pre-eclampsia and growth restriction are discordant, and further research is needed to address the question of placental vascular complications. The increased risk of preterm birth attributed to protease inhibitors should be interpreted with caution considering the discrepant results and the multitude of confounding factors often overlooked. Although data are thus far reassuring, further research is needed to shed light on unresolved controversies about the safety of protease inhibitors during pregnancy.

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Combination antiretroviral therapy with protease inhibitors in HIV-infected pregnancy

Abstract: Women receiving antiretroviral therapy with PI have a similar rate of premature birth and low birth-weight as women receiving antiretroviral therapy without PI or on no medication.

Cited by 11 publications

References 13 publications

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Anti-retroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

Safety of protease inhibitors in HIV-infected pregnant women

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