Background: We analysed ART regimens and pregnancy outcomes in naive and antiretroviral (ART)-experienced HIV-positive women from ICONA cohort and investigated frequency and predictors of detectable viral load (VL) at delivery.
Methods: All pregnancies resulting in live births were included. Based on ART at the beginning of pregnancy, pregnancies were allocated either to the ART-naive or ART-experienced group. Analyses were stratified according to calendar periods. Multivariate logistic regression was used to describe predictors of detectable VL at delivery.
Results: One-hundred-fifty-eight out of 2862 women experienced 169 pregnancies (88 in naives and 81 in 70 ART-experienced women). ART regimens varied according to calendar periods; mono-dual-combination regimens progressively decreased over time [p-value for trend<0.0001]. Protease inhibitor (PI)-including regimens were the most frequently used regimens at delivery [71.6% vs 63.0% in naives and in ART-experienced, p=0.2]. VL was detectable in 35.6% of women at delivery; this was less likely with increasing calendar periods (AOR per 1-year longer: 0.8, 95%CI:0.7-0.9, p=0.007) and more likely in women with HIV-RNA>50 copies/mL at pregnancy ascertainment (AOR: 7.1, 95% CI:1.9-33.3, p=0.006). Nevertheless, no cases of vertical transmission were diagnosed. Pre-term birth-rate of 17.3% [11.9% vs 22.6% naive and ART-experienced, p=0.1] was reported; this was not associated with ART duration or PI-including regimens; 27.2% of infants had <2500 g birth-weight.
Conclusion: Antiretroviral regimens prescribed during pregnancy changed over time according to guidelines. Although undetectable VL was not always achieved, no vertical transmission occurred; pre-term delivery and low birth weight occurred in some cases and still remain key issues.
(C) 2014 by Lippincott Williams & Wilkins