Antiretroviral Regimen and Pregnancy Outcomes of Women Living with HIV in a US Cohort

Abstract

Women who are pregnant and living with HIV have traditionally been excluded from clinical trials regarding new pharmacotherapy. Immediate initiation of antiretroviral therapy (ART) is recommended for women who are pregnant and living with HIV. Given there is limited data regarding the safety of ART in pregnancy, high-quality research of maternal and fetal outcomes in women who are pregnant and on ART is of paramount importance. Integrase inhibitors (INSTIs) are of particular interest as newer data suggests that these can lead to more rapid viral load reduction. This was a retrospective study of women who are pregnant and living with HIV who received prenatal care at the University of Washington. Groups were determined by the ART class: INSTI, protease inhibitors (PI), and non-nucleoside reverse transcriptase inhibitors (NNRTI). Chi-square and t-tests were used as appropriate for the analysis of baseline characteristics and generalized estimating equations to adjust for the rate of HIV viral suppression between groups. There were a total of 235 mother-infant pairs whose pregnancies progressed beyond 20 weeks. The study demonstrated that women on INSTI regimens were more likely to have a shorter time to viral load suppression than women on NNRTI regimens. Additionally, six congenital anomalies were identified in this cohort, none of which were neural tube defects. There was no perinatal transmission of HIV to any of the infants. This small cohort of women provides high-quality data regarding the safety and efficacy of INSTI use in resource-rich settings.