Outcomes related to 4864 pregnancies with exposure to lopinavir/ritonavir (LPV/r)

• Published in: Journal of the International AIDS Society Vol. 17; no. 4 Suppl 3; pp. 19613 - n/a
• Main Authors: Tookey, Pat, Thorne, Claire, Martinez‐Tristani, Marisol, Norton, Michael, Wyk, Jean
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.11.2014; John Wiley & Sons, Inc
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Drug therapy; HIV; HIV patients; Human immunodeficiency virus; Infants; Infections; Lopinavir; Patient outcomes; Perinatal infection; Pregnancy; Pregnant women; Ritonavir; United Kingdom; United Kingdom > UK; Ireland
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.17.4.19613

Introduction During pregnancy, LPV/r is a common anchor drug employed to treat the mother's HIV‐1 infection in addition to reducing the risk of mother‐to‐child transmission (MTCT). The National Study of HIV in Pregnancy and Childhood (NSHPC) conducts a comprehensive population‐based surveillance of HIV infection in pregnant women exposed to antiretroviral therapy (ART) in the UK and Ireland; in 2003–2012 over a third of pregnancies reported to the NSHPC involved exposure to LPV/r. Methods We undertook a retrospective were descriptive analysis of individual NSHPC patient data, using pregnancy as the unit of observation. Clinical outcomes for pregnancies reported by June 2013, where women were exposed to LPV/r and due to deliver between January 2003 and December 2012, are described. Results A total of 4864 LPV/r exposed pregnancies in 4118 women were identified. These resulted in 4702 deliveries with 4759 live and 46 stillborn infants. Seventy five percent of women were born in sub‐Saharan Africa, 13% in the UK or Ireland. Median maternal age at conception was 30 years. Nine hundred and eighty (20%) pregnancies were conceived while taking LPV/r, with a median duration of LPV/r exposure of 270 days. A total of 3884 (80%) pregnancies initiated LPV/r after conception, with a median duration of LPV/r exposure of 107 days. Viral load (VL) close to delivery was available for 4083/4702 (87%) deliveries, with VL <50 c/mL in 73% and <1000 c/mL in 94% of women. VL by timing of LPV/r initiation is shown in Table 1. Sixty three percent of deliveries were by C‐section, of which 62% were classified as elective and 38% as emergency. Among singleton liveborn infants, 13% were born prior to 37 weeks gestation (2.5% <32 weeks) and 15% had birth weight <2500 g (2.3% <1500 g). HIV infection status was available for 4039 (89%) singleton infants. For the periods 2003–2007 and 2008–2012, MTCT rates were 1.1% (95% CI 0.6–1.6) and 0.5% (95% CI 0.2–0.8) respectively. Hundred and thirty four live born children (2.8%) had at least one congenital abnormality reported. Conclusions In the NSHPC database, in women exposed to LPV/r during pregnancy in the UK and Ireland, MTCT rates are low and continue to decline, and are similar to rates in the entire NSHPC cohort of women with diagnosed HIV [1]. The congenital abnormality rate is comparable with that reported for the uninfected population in this geographic region.