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Antiretroviral treatment during pregnancy

Keiser, Olivia; Gayet-Ageron, Angèle; Rudin, Christoph; Brinkhof, Martin WG; Gremlich, Erika; Wunder, Dorothea; Drack, Gero; Hirschel, Bernard; de Tejada, Begoña Martinez; the Swiss HIV Cohort Study (SHCS), the Swiss Mother & Child HIV Cohort Study (MoCHiV)

doi: 10.1097/QAD.0b013e3283189bf1
Clinical Science

Objective: Virologic failure of HIV-positive patients is of special concern during pregnancy. We compared virologic failure and the frequency of treatment changes in pregnant and non-pregnant women of the Swiss HIV Cohort Study.

Methods: Using data on 372 pregnancies in 324 women we describe antiretroviral therapy during pregnancy. Pregnant women on HAART at conception (n = 131) were matched to 228 non-pregnant women (interindividual comparison) and to a time period of equal length before and after pregnancy (intraindividual comparison). Women starting HAART during pregnancy (n = 145) were compared with 578 non-pregnant women starting HAART.

Findings: The median age at conception was 31 years, 16% (n = 50) were infected through injecting drug use and the median CD4 cell count was 489 cells/μl. In the majority of pregnancies (n = 220, 59%), women had started ART before conception. When ART was started during pregnancy (n = 145, 39%), it was mainly during the second trimester (n = 100, 69%). Two thirds (n = 26) of 35 women starting in the third trimester were diagnosed with HIV during pregnancy. The risk of virologic failure tended to be lower in pregnant than in non-pregnant women [adjusted odds ratio 0.52 (95% confidence interval 0.25–1.09, P = 0.08)], but was similar in the intraindividual comparison (adjusted odds ratio 1.04, 95% confidence interval 0.48–2.28). Women starting HAART during pregnancy changed the treatment less often than non-pregnant women.

Conclusion: Despite the physiological changes occurring during pregnancy, HIV infected pregnant women are not at higher risk of virologic failure.

aInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland

bDepartment of Internal Medicine, HIV-AIDS Unit, University Hospital of Geneva, Geneva, Switzerland

cUniversity Children's Hospital Basel, Basel, Switzerland

dDepartment of Internal Medicine, HIV-AIDS Unit, University Hospital of Zürich, Zürich, Switzerland

eDepartment of Obstetrics and Gynecology, University Hospital Bern, Bern, Switzerland

fDepartment of Obstetrics and Gynecology, St. Gallen, Rothenberg, Switzerland

gDepartment of Gynecology and Obstetrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.

Received 30 May, 2008

Revised 1 September, 2008

Accepted 5 September, 2008

Correspondence to B. Martinez de Tejada, Department of Gynecology and Obstetrics, University Hospitals of Geneva and University of Geneva, 30 Bd de la Cluse, CH-1211 Genève 14, Switzerland. Tel: +41 22 382 68 16; fax: +41 22 382 41 46; e-mail: Begona.MartinezDeTejada@hcuge.ch

Copyright © 2008 Wolters Kluwer Health, Inc.