Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception

Huntington, Susie E, Bansi, Loveleen K, Thorne, Claire, Anderson, Jane, Newell, Marie-Louise, Taylor, Graham P, Pillay, Deenan, Hill, Teresa, Tookey, Pat A, Sabin, Caroline A, The UK Collaborative HIV Cohort (UK CHIC) Study, , The National Study of HIV in Pregnancy and Childhood (NSHPC), and Fisher, Martin (2011) Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception. AIDS, 25 (13). pp. 1647-1655. ISSN 0269-9370

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Abstract

OBJECTIVES

To describe antiretroviral therapy (ART) use and clinical status, at start of and during pregnancy, for HIV-positive women receiving ART at conception, including the proportion conceiving on drugs (efavirenz and didanosine) not recommended for use in early pregnancy.

METHODS

Women with a pregnancy resulting in a live-birth after 1995 (n = 1537) were identified in an observational cohort of patients receiving HIV care at 12 clinics in the UK by matching records with national pregnancy data. Treatment and clinical data were analysed for 375 women conceiving on ART, including logistic regression to identify factors associated with changing regimen during pregnancy.

RESULTS

Of the 375 women on ART, 39 (10%) conceived on dual therapy, 306 (82%) on triple therapy and 30 (8%) on more than three drugs. In total, 116 (31%) women conceived on a regimen containing efavirenz or didanosine (69 efavirenz, 54 didanosine, seven both). Overall, 38% (143) changed regimen during pregnancy, of whom 44% (n = 51) had a detectable viral load around that time. Detectable viral load was associated with increased risk of regimen change [adjusted odds ratio 2.97, 95% confidence interval (CI) (1.70-5.19)], while women on efavirenz at conception were three times more likely to switch than women on other drugs [3.40, (1.84-6.25)]. Regimen switching was also associated with year at conception [0.89, (0.83-0.96)].

CONCLUSION

These findings reinforce the need for careful consideration of ART use among women planning or likely to have a pregnancy in order to reduce viral load before pregnancy and avoid drugs not recommended for early antenatal use.

Item Type: Article
Additional Information: Martin Fisher is not a named author on the this article but is a member of The UK Collaborative HIV Cohort (UK CHIC) Study
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
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Depositing User: Ellen Thomas
Date Deposited: 11 Feb 2014 09:52
Last Modified: 11 Feb 2014 09:52
URI: http://sro.sussex.ac.uk/id/eprint/47293
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