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Session 139
Poster Abstracts Impact of Antiretroviral Therapy during Pregnancy Friday, 1:30 - 3:30 pm Hall B |
Background: Treatment of HIV-1+ pregnant women
and their babies with ART has drastically decreased the perinatal
transmission of HIV. Some studies suggest that HIV+ women have a
higher risk of adverse outcomes during pregnancy than HIV– women but
results regarding the effect of ART prior to conception are still limited. We
evaluated the incidence of adverse effects on pregnancy in women receiving ART
before pregnancy and compared to those who started treatment after the first
trimester.
Methods: A prospective cohort of HIV-1+
pregnant women followed from 1996 to 2003, at a referral center for HIV+
pregnant women (IPPMG/HUCFF – UFRJ) in Rio de Janeiro, Brazil, was studied of
whom 80 were being treated with dual (30 patients; 37.5%) or triple therapy (50;
62.5%) at the time of conception. Triple therapy consisted of 2 nucleoside
reverse transcriptase inhibitors (NRTI) + nelfinavir (NFV)
(35 patients) or nevirapine (NVP) (14 patients), and 1
got pregnant while using efavirenz (EFV) (which was
changed to NVP afterward). A total of 434 women started ART after the first
trimester of pregnancy (monotherapy with zidovudine [AZT], 45.4%; dual therapy, 40.8%; triple
therapy, 13.8%).
Results: Use of ART before conception was related to a
higher risk of elective caesarean section (RR: 1.59, 95% CI 1.25 to 2.05) and
low birth weight (RR: 1.81, 95% CI 1.08 to 3.02). Congenital anomalies were
observed only in babies born to women treated after the first trimester of
pregnancy (AZT: 4 patients; AZT+lamivudine [3TC]: 4 patients,
HAART: 1 patient). At delivery, 12 babies presented complications: oligohydramnios, 2
babies; anoxia, 4; anoxia + oligohydramnios or low
birth weight, 3; meconium aspiration, 3. Two of these
events occurred in babies whose mother was using ART prior to gestation.
Vertical transmission in the cohort was 1.2% and was seen only in mothers who
started therapy after the first trimester of gestation. Adverse effects are
summarized in the table below.
Conclusions:
HIV-infected women who started treatment
with ART prior to conception have a higher risk of emergency caesarean section
and of delivering a baby of low birth weight, however preterm delivery, congenital
anomalies, and complications in the newborn do not seem to be increased in this
situation.
Keywords: HIV-1 pregnant women; antiretrovirals; pregnancy outcome
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