Prescribing patterns of antiretroviral treatments during pregnancy for women living with HIV in Canada 2004–2020: A surveillance study

Abstract

Background While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. Methods The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as ‘preferred/alternative’ as per HHS HIV perinatal guidelines, or ‘other than preferred/alternative’. Results We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. Conclusion In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.

Variations in CD4 counts during pregnancy in women living with HIV

“…First, as enrolment occurred at the first pregnancy visit, we did not document the exact timing of ART initiation if it was before pregnancy. Second, these results were obtained in a Canadian setting, where most pregnant women living with HIV were treated with protease inhibitor‐based or integrase strand transfer inhibitor‐based ART before conception [8]. So, our results may not be generalizable to other settings.…”

“…In the past, CD4 counts were used to determine when antiretroviral therapy (ART) should be initiated, but initiating ART as soon as HIV infection is diagnosed is now recommended regardless of the CD4 count [3][4][5], particularly in pregnant women living with HIV, as this is associated with a decreased risk of vertical HIV transmission [4,6,7]. Of note, most pregnant women living with HIV in high-resource settings are now on ART before conception [8].…”

Impact of maternal HIV infection on perinatal outcomes: A systematic review

“…Although our systematic review provides valuable insights into the association between maternal HIV infection and adverse perinatal outcomes, it is essential to acknowledge the evolving landscape of ARV therapy over time. Previous studies 31–33 have documented varying ARV regimens used in the management of HIV infection during pregnancy, ranging from older treatment protocols, such as zidovudine (AZT) monotherapy or dual nucleoside reverse transcriptase inhibitor (NRTI) therapy 31 to more contemporary combinations, including highly active antiretroviral therapy (HAART) and fixed‐dose combination (FDC) therapy 32 . These regimens differ not only in their efficacy in suppressing viral load but also in their potential side effects and impact on pregnancy outcomes.…”

Type and timing of antiretroviral therapy during pregnancy: Impact on risk of preterm delivery and small‐for‐gestational age births in Canada, a retrospective cohort study

“…4 Yet, even after taking into account these influences, HIV infection has still been consistently linked to PTD and SGA birth. 1,2 With the increasing use of antiretroviral therapy (ART) in pregnancy, 5 there have been variable reports in the literature regarding whether type and/or timing of specific ART combinations may influence the risk of adverse pregnancy outcomes. [6][7][8] Data are conflicted within and among countries, [6][7][8][9][10] and very few publications include data on integrase inhibitors.…”