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Does pregnancy affect the early response to cART?

Rachas, Antoinea; Warszawski, Josianea,b,c; Le Chenadec, Jérômea; Legeai, Camillea; Teglas, Jean-Paula; Goujard, Cécilea,b,d; Rouzioux, Christinee; Mandelbrot, Laurenta,f; Tubiana, Rolandg; Meyer, Laurencea,b,c

doi: 10.1097/QAD.0b013e32835ac8bc
Clinical Science

Objective: A part of women starting antiretroviral therapy during pregnancy fail to attain undetectable viral load by delivery. Here we studied whether pregnancy affects the early immunovirological response to combined antiretroviral therapy (cART), taking into account treatment duration and baseline characteristics.

Design: Antiretroviral-naive women initiating cART since 2004 and followed in three French ANRS multicenter HIV cohorts (French Perinatal Cohort, PRIMO and COPANA).

Methods: The early virological response (at 1, 3 and 6 months) and immunological increase after cART initiation were compared between women starting cART during (n = 708) and outside (n = 110) pregnancy. Relative risks were estimated in multivariate models adjusted for treatment duration, baseline viral load and CD4, sociodemographic factors and chronic hepatitis B. CD4 increases were compared by using mixed models.

Results: Only 63.8% of treated pregnant women attained a viral load less than 50 copies/ml by delivery. Similarly to nonpregnant women, nearly 90% of pregnant women reached a viral load less than 400 copies/ml at M3 [adjusted RR: 1.0 (95% confidence interval 0.7–1.4)], and nearly 100% at M6 following cART initiation [0.9 (0.4–1.9)]. viral load less than 50 copies/ml was attained by 61.5% of pregnant versus 67.9% of nonpregnant women at M3 (P = 0.26), and by 82.1 versus 87.0% at M6 (P = 0.48). CD4 recovery (both number and percentage) was similar in pregnant and nonpregnant women. Results were similar for the subset of women starting a boosted protease inhibitor-containing cART.

Conclusion: Pregnancy does not affect the virological response to cART below 400 copies/ml, or CD4 increase. The main reason for pregnant women not achieving viral load less than 50 copies/ml at delivery appears to be a short duration of treatment.

aInserm, Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of HIV and STI Team, Le Kremlin-Bicêtre

bParis Sud University

cDepartment of Public Health, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris

dDepartment of Internal Medicine, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris

eParis Descartes University; Department of Virology, Hospital Necker-enfants malades, Assistance Publique-Hôpitaux de Paris, Paris

fDepartment of Obstetrics and Gynaecology, Hospital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes and Université Paris-Diderot

gDepartment of Infectious and Tropical Diseases, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Inserm U943, Paris, France.

Correspondence to Antoine Rachas, Inserm CESP U1018 HIV Team. 82, rue du Général Leclerc 94276 Le Kremlin-Bicêtre Cedex, France. Tel: +33 1 49 59 53 17; e-mail: antoine.rachas@gmail.com

Received 25 September, 2012

Accepted 26 September, 2012

© 2013 Lippincott Williams & Wilkins, Inc.