712 
Pregnancy Outcomes after Combined ART or Short-course AZT with Single-dose Nevirapine in Thai Women with High and Low CD4 Cell Counts
Nittaya Phanuphak*1, T Apornpong1, S Teeratakulpisarn1, S Limpongsanurak2, W Luesomboon3, A Tangsathapornpong4, C Vitavasiri5, N Singhakowinta6, E Abrams7, P Phanuphak1, and MTCT-Plus Initiative, Bangkok, Thailand
1Thai Red Cross AIDS Res Ctr, Bangkok; 2King Chulalongkorn Memorial Hosp, Bangkok, Thailand; 3Queen Sawangwattana Memorial Hosp, Chonburi, Thailand; 4Thammasat Univ Hosp, Pathumthani, Thailand; 5Police Gen Hosp, Bangkok, Thailand; 6Queen Sirikit hosp, Chonburi, Thailand; and 7Columbia Univ, Mailman Sch of Publ Hlth, New York, NY, US
Background: The
objectives of treatment for HIV-infected pregnant women are to maximize women’s
health, minimize mother-to-child transmission (MTCT)of HIV while preserving
future treatment options for women. In the developed world, both protease
inhibitor-based and nevirapine (NVP)-based regimens are used, while the latter
are more likely to be prescribed in the developing world. However, data are
conflicting, whether the use of these regimens is associated with adverse
pregnancy outcomes.
Methods: Before
April 2004, the Thai Red Cross AIDS Research Centre prevention of MTCT regimen
was zidovudine (AZT) with single-dose (sd) NVP. After April 2004, all
HIV-infected pregnant women received AZT/lamivudine (3TC)/NVP regardless of
baseline CD4+ count. Pregnant women with baseline CD4+ ≤200 or >200
cells/mm3 started the regimen as early as 14 or 28 weeks,
respectively. Data on pregnancy outcomes were retrieved from chart review from
January 2003 to September 2005.
Results: There
were 352 pregnancy outcomes for 352 women. Mean duration on ART was 6.5 weeks
in AZT + sdNVP group and 10.9 weeks in AZT/3TC/NVP group. Due to limited data
in women on AZT + sdNVP with low CD4+ counts, we could only compare
the effect of ART regimens among women with high CD4+ counts and
could not detect any difference in pregnancy outcomes between AZT + sdNVP and
AZT/3TC/NVP groups. Among AZT/3TC/NVP group, CD4 ≤200 (RR = 2.1, 95%CI 1.1 to 3.9) and body mass
index <24.5 (RR = 1.3, 95%CI 1.1 to 1.7) were risk factors for low birth
weight. None of these remained significant by multivariate analysis. Neither duration
on ART, ART discontinuation/switch, parity, nor age was associated with adverse
pregnancy outcomes.
|
Pregnancy outcomes (%)
|
AZT + sdNVP
|
AZT/3TC/NVP
|
RR
(95%CI)**
|
|
CD4 ≤200
n = 2
|
CD4
>200
n = 63
|
Total
n = 65
|
CD4 ≤200
n = 94
|
CD4
>200
n = 178
|
Total n = 272
|
RR
(95%CI)*
|
|
Low birth
weight
<2500 g
Preterm birth
(<37 weeks)
Stillbirth
Neonatal
death
|
0
0
0
0
|
8.5
14.3
1.6
0
|
8.2
13.8
1.5
0
|
20.5
18.1
3.2
0
|
9.8
12.4
2.2
1.1
|
13.5
14.3
2.6
0.7
|
2.1 (1.1-3.9)
0.9 (0.8-1.0)
1.0 (0.9-1.0)
1.0 (1.0-1.0)
|
0.9 (0.3-2.3)
1.0 (0.9-1.1)
1.0 (1.0-1.0)
1.0 (1.0-1.0)
|
|
Transmission
rate
|
0
|
7.0
|
6.8
|
3.6
|
1.5
|
2.5
|
0.595
|
0.226
|
|
|
|
|
|
|
|
|
|
|
|
* AZT/3TC/NVP
group, CD4<200 vs >200 ** CD4>200 only, AZT + SD-NVP vs
AZT/3TC/NVP
Conclusions: At
least among women with high CD4 cell counts, NVP-based ART used in HIV-infected
pregnant women was not associated with increased incidence of adverse pregnancy
outcomes as compared with AZT + sdNVP and should be considered as a possible
option for prevention of MTCT in the developing world.
|
