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. 2024 Jan 1;38(1):21-29.
doi: 10.1097/QAD.0000000000003616. Epub 2023 Jun 6.

Modern antiretroviral regimens in pregnant women: virologic outcomes and durability

Christiana Smith  1 , Lori Silveira  1 , Megan Crotteau  1 , Krystle Garth  1 , Jennifer Canniff  1 , Kirk B Fetters  2 , Sarah Lazarus  3 , Shannon Capraro  4 , Adriana Weinberg  1   5 ; the CHIP Perinatal Team
Affiliations

Modern antiretroviral regimens in pregnant women: virologic outcomes and durability

Christiana Smith et al. AIDS. .

Abstract

Objectives: Data are lacking on the virologic efficacy and durability of modern antiretroviral treatment (ART) regimens during pregnancy. We compared virologic outcomes at delivery among women receiving dolutegravir versus other ART and the rate of change of the initial pregnancy regimen.

Design: Single-site retrospective cohort between 2009 and 2019.

Methods: We used univariable and multivariable generalized estimating equations to model the relationship between the maternal ART anchor and the proportion of women with a detectable viral load (greater than or equal to 20 HIV RNA copies/mL of plasma) closest to delivery (suboptimal virologic control) and with a detectable viral load at any time in the third trimester. We also compared changes in ART during pregnancy.

Results: We evaluated 230 pregnancies in 173 mothers. Rates of optimal virologic control at delivery did not significantly differ in mothers who received dolutegravir (93.1%), rilpivirine (92.1%), boosted darunavir (82.6%), or efavirenz (76.9%) but were significantly lower among mothers receiving atazanavir (49.0%) or lopinavir (40.9%). The odds of having a detectable viral load at any time in the third trimester was also higher for atazanavir and lopinavir. Raltegravir, elvitegravir, or bictegravir were used in less than 10 mothers at delivery, which precluded statistical analyses. The frequency of change in ART was significantly higher in mothers who initially received elvitegravir (68%) or efavirenz (47%) than dolutegravir (18%).

Conclusion: Dolutegravir-containing, rilpivirine-containing, and boosted darunavir-containing regimens conferred excellent virologic control in pregnancy. Atazanavir and lopinavir, elvitegravir, and efavirenz were associated with either high rates of virologic failure or regimen change during pregnancy.

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Conflict of interest statement

Conflicts of interest

A.W. receives research grants from the Merck and GSK vaccine divisions for work unrelated to this manuscript (money to University of Colorado) and honoraria from Seqirus and GSK vaccine divisions for work unrelated to this manuscript. All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1.
Fig. 1.. Flowchart of pregnancies managed by the Children’s Hospital Immunodeficiency Program (CHIP) clinic who were included in this study.
ART, antiretroviral treatment; INSTI, integrase inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; PI, protease inhibitor.
See this image and copyright information in PMC

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