Rapid Reduction in HIV Viral Load in Late Pregnancy with Raltegravir

Abstract

The use of raltegravir (RAL) is not preferred to prevent perinatal transmission in pregnancy due to lack of safety and pharmacokinetic data in this population. Data have been limited to few case reports of patients who present for treatment late in pregnancy, have multidrug resistance, or have poor adherence, requiring an additional class such as an integrase inhibitor to further lower viral load. This case report describes and supports the initiation of RAL in very late pregnancy (week 33) to rapidly decrease viral load and successfully prevent perinatal transmission. By increasing the efficacy and safety data of RAL use in pregnancy, we believe this report can help provide some guidance on the management of complex cases.

Integrase inhibitors in late pregnancy and rapid HIV viral load reduction

“…15–17 The previous collection of case reports has also shown rapid decline in plasma viral loads similar to our study. 15,16,18–2021,2223 A single case report described maternal hepatic toxicity, which diminished after discontinuation of raltegravir. Monitoring of transaminases should occur with INSTI use during pregnancy.…”

Tratamiento anti-retroviral conteniendo raltegravir en mujeres gestantes con infección por VIH: Revisión sistemática

“…Diez de los estudios incluidos se trataron de reportes de caso [27][28][29][30][31][32][33][34]36,38 y los cuatro restantes fueron cartas al Editor en las que se presentaban también reportes de casos clínicos 35,37,39,40 . No se encontraron revisiones sistemáticas, ensayos clínicos comparados o estudios observacionales.…”

“…Los estudios con más casos reportados fueron el de Nóbrega I, 2013 31 , que reportó 14 casos provenientes de Brasil, y el de Cecchini D, 2014 27 , que presentó 10 casos clínicos, provenientes de Argentina. Sin embargo, la mitad de los artículos considerados en esta revisión, reportaron un solo caso 28,30,[32][33][34]37,40 .…”

“…El único desenlace evaluado en esta revisión fue la TMI del VIH. La TMI fue evaluada mediante pruebas de ADN proviral para VIH [27][28][29]33,35,39,40 o pruebas de ARN del VIH 31,32,36,37 en los niños nacidos de madres con infección por VIH. En un estudio se utilizaron ambos métodos para establecer la TMI 30 , mientras que en dos estudios 34,38 no se señaló cuál fue el método utilizado.…”

BritishHIVAssociation guidelines for the management ofHIVinfection in pregnant women 2012 (2014 interim review)

“…efavirenz) or in combination with other antiretrovirals . It is important to note that no adequate or well‐controlled studies of raltegravir have been conducted in pregnant women; however, case reports and small case series reporting rapid HIV decay with raltegravir‐based regimens are appearing in the medical literature [150–154]. Pharmacokinetic data presented in Recommendation 5.2.4 indicate that no dose change is required in the third trimester.…”