Tenofovir use and pregnancy among women initiating HAART

• Published in: AIDS (London) Vol. 26; no. 18; pp. 2393 - 2397
• Main Authors: MASKEW, Mhairi, WESTREICH, Daniel, FIRNHABER, Cindy, SANNE, Ian
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 28.11.2012
• Subjects: Adenine - analogs & derivatives; Adenine - pharmacology; Adenine - therapeutic use; Adolescent; Adult; AIDS/HIV; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral Therapy, Highly Active; Antiviral agents; Biological and medical sciences; CD4 Lymphocyte Count; Female; Follow-Up Studies; HIV Seropositivity - drug therapy; HIV Seropositivity - epidemiology; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Disease Transmission, Vertical - prevention & control; Infectious diseases; Medical sciences; Middle Aged; Organophosphonates - pharmacology; Organophosphonates - therapeutic use; Pharmacology. Drug treatments; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - prevention & control; Proportional Hazards Models; Prospective Studies; Risk Assessment; South Africa - epidemiology; Tenofovir; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Women's Health; South Africa; Antiretroviral agent; RNA-directed DNA polymerase; antiretroviral therapy; Nucleotide analog; Epidemiology; Tenofovir; Reverse transcriptase inhibitor; Nucleoside analog; Antiviral; Female; Woman; Human; Immunopathology; Purine nucleotide; Acyclic nucleotide; Enzyme; Transferases; Enzyme inhibitor; AIDS; Organic phosphonate; Immune deficiency; Infection; Pregnancy; Nucleotidyltransferases; Chemotherapy; Treatment; Viral disease; women's health
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e328359a95c

Recent studies have raised concerns about a change in rates of pregnancy among HIV-negative women exposed to tenofovir. Here, our objective was to determine among HIV-positive women whether use of tenofovir at HAART initiation or thereafter is associated with subsequent changes in incidence of pregnancy. Analysis of prospectively collected clinical data. We used Cox proportional hazards models and logistic regression to estimate hazard ratios and odds ratios for the association of baseline tenofovir use and first incident pregnancy. We used marginal structural Cox models to estimate hazard ratios for the association of current tenofovir use and time to first incident pregnancy. We studied 7275 women, of whom 1199 were initiated on tenofovir-based HAART regimens, and who experienced a total of 894 pregnancies in 17,200 person-years of follow-up. Analyses showed slight reductions in hazards of pregnancy among women who used tenofovir but without sufficient precision to draw strong conclusions. Sensitivity analyses confirmed main results. Tenofovir may be associated with a lower hazard or rate of pregnancy in women receiving HAART. However, conclusions are limited by low precision, the observational nature of the data, and possible uncontrolled confounding by temporal trends in contraception use and other factors.