Use of antiretroviral therapy in pregnancy and association with birth outcome among women living with HIV in Denmark: A nationwide, population‐based cohort study

Abstract

Objective To describe antiretroviral therapy (ART) regimens during pregnancy among women living with HIV (WLWH) in Denmark and to examine the association between ART use in pregnancy and adverse birth outcomes. Methods A population‐based cohort study including all pregnancies among WLWH in Denmark between 2000 and 2019. Data were collected through national registries. Temporal trends of ART use in pregnancy were evaluated. Logistic regression models were used to examine the association of ART use in pregnancy and other risk factors with adverse birth outcomes. Results In total, 589 pregnancies were included. Combination treatment with a nucleoside reverse transcriptase inhibitor (NRTI) and a protease inhibitor (PI) was the most common ART regimen (96%). ART regimen, PI use in pregnancy and timing of ART initiation were not significantly associated with increased odds of preterm birth, small for gestational age or low birth weight. First‐trimester initiation of ART was significantly associated with increased odds of intrauterine growth restriction in the multivariate analysis [adjusted odds ratio (aOR) = 3.78, 95% confidence interval (CI): 1.23–11.59], while first trimester PI use was associated with increased odds of IUGR in the univariate analysis only [OR = 3.24, 95% CI: 1.13–9.30]. Smoking, comorbidity, and maternal HIV RNA ≥ 50 copies/mL were independently associated with increased odds of adverse birth outcomes. Conclusions Pregnant WLWH living in Denmark are generally well treated with HIV RNA < 50 copies/mL at delivery and NRTI + PI as the most common ART regimen used in pregnancy. Initiation of ART in the first trimester may be associated with poor fetal growth. The association between ART use in pregnancy and adverse birth outcomes may partly be explained by maternal risk factors.

Adverse pregnancy outcomes associated with antiretroviral therapy initiated before pregnancy and during pregnancy: a retrospective study in Hubei province, China

“…Therefore, the use of ART before pregnanc y has rapidly increased since most women living with HIV are of childbearing potential ( 1 ). Consistent with the results of other studies in Europe ( 6 , 23 ), we observed that LPV/r-based regimens and NNRTI, especially EFV-based regimens, were the commonly used ART regimen among PWLHIV. The proportion of LPV/r use has been increasing in recent years, per our study findings.…”

“…However, further multivariate analysis revealed no significant increased risk of PTB associated with LPV/r-NRTIs initiated before and during pregnancy. PI, especially LPV/r based regimens, have been reported to be associated with an increased risk of PTB in comparison to AZT monotherapy ( 8 , 24 ) or NNRTIs based regimens ( 7 ) or non-PI based regimens ( 33 ), although the related data still remains controversial ( 6 , 34 – 36 ). A multi-center observational study across eight European countries found an increased risk of PTB among PWLHIV with LPV/r-based regimens initiation before pregnancy but no increased risk of PTB associated with LPV/r-based regimens initiated during pregnancy ( 23 ).…”

Trends in management and outcomes of pregnant women living with HIV between 2008–2013 and 2014–2019: A retrospective cohort study

“…Vertical transmission of HIV occurred in one delivery (0.86%). This is similar to the national finding of a 0.27% transmission rate between 2012 and 2014 ( 8 ), as well as rates reported from both the UK and other high-income countries over the last 10 years ( 26 , 28 , 30 , 31 , 33 , 35 , 41 , 42 ). The preterm delivery rate of 11.2% is lower than the national rate of 12.5% amongst WLHIV, but remains considerably higher than the national rate of 7.8% amongst all women ( 14 , 43 ).…”

“…The rate of low birth weight was 16%. This is comparable to national UK data ( 44 ), whilst other similar cohorts in high-income countries report rates ranging from 12 to 25% ( 28 , 41 , 42 , 45 , 46 ). Fifteen percent of infants were SGA.…”

“…The proportion of WLHIV with a viral load <50 copies/mL at delivery (90% overall, and 94% in the most recent period) is higher than in other studies from the last 10 years ( 6 , 28 , 29 , 31 , 33 , 35 , 40 ), and higher than the national figure of 87% between 2012 and 2014 ( 8 ). The proportion of WLHIV delivering vaginally in the present study increased from 27 to 43%.…”