Article

Premature delivery in HIV-infected women starting protease inhibitor therapy during pregnancy: role of the ritonavir boost?

CESP INSERM U1018, Le Kremlin-Bicêtre, Colombes, France.
Clinical Infectious Diseases (impact factor: 9.15). 05/2012; 54(9):1348-60. DOI:10.1093/cid/cis198
Source: PubMed

ABSTRACT The association between combination antiretroviral (cARV) therapy use by human immunodeficiency virus (HIV)-infected women during pregnancy and risk of prematurity is still controversial. We explored this question, focusing on the initiation of ritonavir-boosted protease inhibitors (PIs) during pregnancy, which is now standard care.
Trends in prematurity (<37 gestational weeks) were studied among all singleton pregnancies in the Agence Nationale de Recherche sur le SIDA (ANRS) French Perinatal Cohort from 1990 through 2009 (n = 13 271). In-depth analysis was conducted in a more detailed substudy of the cohort, among women starting PI-based ARV therapy during pregnancy (n = 1253). Multivariable analysis adjusted for immunovirological status and known risk factors for prematurity.
Prematurity increased from 9.2% during 1990-1993 (no therapy) and 9.6% during 1994-1996 (mostly zidovudine monotherapy) to 12.4% during 1997-1999 (dual-nucleoside analog therapy) and 14.3% during 2005-2009 (routine cARV therapy; P < .01). Prematurity was associated with cARV therapy, compared with zidovudine monotherapy, with an adjusted odds ratio of 1.69 (95% confidence interval [CI], 1.38-2.07; P < .01) when accounting for maternal age, intravenous drug use, geographic origin, and CD4 cell count. During 2005-2009, the prematurity rate was higher with boosted than with nonboosted PI therapy started during pregnancy (14.4% vs 9.1% [P = .05]; adjusted hazard ratio, 2.03 [95% CI, 1.06-3.89; P = .03] in multivariate analysis). The difference concerned mainly induced preterm delivery for maternal or fetal indications (5.6% vs 1.6%; P = .02),
The prematurity rate among HIV-infected pregnant women was twice that in the general population in France; this was not entirely explained by sociodemographic characteristics. Prematurity was independently associated with cARV therapy and, particularly, with the initiation of ritonavir-boosted PI therapy during pregnancy.

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    Article: Small-for-gestational-age births in pregnant women with HIV, due to severity of HIV disease, not antiretroviral therapy.
    Erika Aaron, Alexa Bonacquisti, Leny Mathew, Gregg Alleyne, Laura P Bamford, Jennifer F Culhane
    [show abstract] [hide abstract]
    ABSTRACT: To determine rate and factors associated with small-for-gestational-age (SGA) births to women with HIV. Prospective data were collected from 183 pregnant women with HIV in an urban HIV prenatal clinic, 2000-2011. An SGA birth was defined as less than the 10th or 3rd percentile of birth weight distribution based upon cut points developed using national vital record data. Bivariate analysis utilized chi-squared and t-tests, and multiple logistic regression analyses were used. The prevalence of SGA was 31.2% at the 10th and 12.6% at the 3rd percentile. SGA at the 10th (OR 2.77; 95% CI, 1.28-5.97) and 3rd (OR 3.64; 95% CI, 1.12-11.76) percentiles was associated with cigarette smoking. Women with CD4 count>200 cells/mm3 at the first prenatal visit were less likely to have an SGA birth at the 3rd percentile (OR 0.29; 95% CI, 0.10-0.86). Women taking NNRTI were less likely to have an SGA infant at the 10th (OR 0.28; 95% CI, 0.10-0.75) and 3rd (OR 0.16; 95% CI, 0.03-0.91) percentiles compared to those women on PIs. In this cohort with high rates of SGA, severity of HIV disease, not ART, was associated with SGA births after adjusting for sociodemographic, medication, and disease severity.
    Infectious Diseases in Obstetrics and Gynecology 01/2012; 2012:135030.
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Keywords

<37 gestational weeks
 
adjusted odds ratio
 
cARV therapy
 
detailed substudy
 
dual-nucleoside analog therapy
 
geographic origin
 
hazard ratio
 
HIV)-infected women
 
HIV-infected pregnant women
 
In-depth analysis
 
Multivariable analysis
 
multivariate analysis
 
nonboosted PI therapy
 
PI-based ARV therapy
 
risk factors
 
ritonavir-boosted PI therapy
 
routine cARV therapy
 
singleton pregnancies
 
standard care
 
zidovudine monotherapy