Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 17;64(12):e01068-20.
doi: 10.1128/AAC.01068-20. Print 2020 Nov 17.

Efficacy of Three Antiretroviral Regimens Initiated during Pregnancy: Clinical Experience in Rio de Janeiro

Maria de Lourdes Benamor Teixeira  1   2 , Trevon L Fuller  1 , Maria Isabel Fragoso Da Silveira Gouvêa  1   2 , Maria Letícia Santos Cruz  1 , Loredana Ceci  1 , Fellipe Pinheiro Lattanzi  1 , Leon Claude Sidi  1 , Wallace Mendes-Silva  3 , Karin Nielsen-Saines  4 , Esau Custodio Joao  5
Affiliations

Efficacy of Three Antiretroviral Regimens Initiated during Pregnancy: Clinical Experience in Rio de Janeiro

Maria de Lourdes Benamor Teixeira et al. Antimicrob Agents Chemother. .

Abstract

Few studies have compared the clinical efficacy and adverse events of combined antiretroviral therapy (cART) regimens in pregnant women seeking obstetrical care. The objective of this study was to compare the efficacy (virus load response), adverse events, and obstetrical and neonatal outcomes of three different regimens of cART in HIV-infected pregnant women initiating treatment in Rio de Janeiro, Brazil. This was a retrospective cohort study of cART-naive pregnant women who initiated either ritonavir-boosted protease inhibitors (atazanavir or lopinavir), efavirenz, or raltegravir plus a backbone regimen. From 2014 to 2018, 390 pregnant women were followed over time. At baseline, the median viral load (VL) for HIV was 4.1 log copies/ml. Among participants who received cART for 2 to 7 weeks, the VL decline was greater for raltegravir (2.24 log copies/ml) than for efavirenz or protease inhibitors (P < 0.001). Virologic suppression was achieved in 87% of women on raltegravir near delivery versus 73% on efavirenz and 70% on protease inhibitors (P = 0.011). Patients on raltegravir achieved virologic suppression faster than those on other regimens (P = 0.019). Overall, the HIV perinatal infection rate was 1.5%. This clinical study compared three potent and well-tolerated cART regimens and demonstrated that a higher proportion of participants on raltegravir achieved an undetectable HIV VL near delivery (P = 0.011) compared to the other arms. These findings suggest that raltegravir-containing regimens are optimal regimens for women with HIV initiating treatment late in pregnancy.

Keywords: HIV; cesarean; efavirenz; integrase inhibitors; mother-to-child transmission; nonnucleotide reverse transcriptase inhibitors; obstetrics; perinatal transmission; pregnancy; protease inhibitors; raltegravir.

PubMed Disclaimer

Figures

FIG 1
FIG 1
(A) Flow chart of participants enrolled in the efficacy, obstetric, and neonatal outcomes analysis (n = 390 final participants). *, some participants met multiple exclusion criteria. (B) Flow chart of participants enrolled in the analysis of adverse events (n = 470 final participants).
FIG 2
FIG 2
Comparison of virologic suppression during pregnancy among patients in different regimens.
See this image and copyright information in PMC

References

    1. U.S. Department of Health and Human Services. 2020. The global HIV/AIDS epidemic—data and trends: global statistics. U.S. Department of Health and Human Services, Washington, DC: https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics. Accessed 22 September 2020.
    1. Bartlett J, Redfield R, Pham P. 2019. Bartlett’s medical management of HIV infection. Oxford University Press, Oxford, United Kingdom.
    1. British HIV Association. 2019. Management of HIV Infection in pregnancy and postpartum 2018 (2019 interim update). BHIVA, London, United Kingdom.
    1. WHO. 2018. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines. Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection World Health Organization, Geneva, Switzerland.
    1. AIDSInfo. 2019. Panel on Antiretroviral Guidelines for Adults and Adolescents: guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services, Washington, DC.

Substances