Timing of Antiretroviral Therapy

Abstract Background Combination antiretroviral therapy (cART) initiation during pregnancy reduces the risk of perinatal human immunodeficiency virus (HIV) transmission; however, studies have suggested that there may be unintended adverse consequences on birth outcomes for selected cART regimens. Met...

Full description

Saved in:
Bibliographic Details
Published inThe Journal of infectious diseases Vol. 226; no. 4; pp. 687 - 695
Main Authors Quinn, M K, Williams, Paige L, Muhihi, Alfa, Duggan, Christopher P, Ulenga, Nzovu, Alwy Al-Beity, Fadhlun M, Perumal, Nandita, Aboud, Said, Fawzi, Wafaie W, Manji, Karim P, Sudfeld, Christopher R
Format Journal Article
LanguageEnglish
Published US Oxford University Press 04.09.2022
Subjects
birth outcomes
ART
antiretrovirals
cART
pregnancy
Online AccessGet full text

Cover

More Information
Summary:Abstract Background Combination antiretroviral therapy (cART) initiation during pregnancy reduces the risk of perinatal human immunodeficiency virus (HIV) transmission; however, studies have suggested that there may be unintended adverse consequences on birth outcomes for selected cART regimens. Methods We analyzed adverse birth outcomes among a prospective cohort of 1307 pregnant women with HIV in Dar es Salaam who initiated cART during the first or second trimester of a singleton pregnancy. Our primary analysis compared birth outcomes by gestational age at cART initiation among these women initiating cART in pregnancy. Results Among women who initiated cART in pregnancy, there was no relationship of gestational age at cART initiation with the risk of fetal death or stillbirth. However, women who initiated cART before 20 weeks of gestation compared with after 20 weeks had increased risk of preterm birth (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.03–1.67) but decreased risk of small-for-gestational age birth (RR, 0.71; 95% CI, .55–.93). Conclusions With increasing use of cART preconception and early in pregnancy, clinicians should be aware of the benefits and potential risks of cART regimens to optimize birth outcomes. In a cohort of women with HIV initiating combination antiretrovirals for the first time during pregnancy, we observed increased preterm birth, decreased small-for-gestational age birth, and no differences in fetal death between early versus late treatment initiators.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiac224