Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes

Maria C. Marazzi, Leonardo Palombi, Karin Nielsen-Saines, Jere Haswell, Ines Zimba, Nurja A. Magid, Ersilia Buonomo, Paola Scarcella, Susanna Ceffa, Giovanna Paturzo, Pasquale Narciso, Giuseppe Liotta

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate pregnancy outcomes in a cohort of HIV-infected women receiving triple antiretroviral therapy (ART) for prevention of mother-to-child-transmission. Methods: A retrospective cohort study with review of records of 3273 HIV-positive women receiving prenatal care in Malawi and Mozambique from July 2005 to December 2009 was conducted in Drug Resource Enhancement Against AIDS and Malnutrition (DREAM) centers. Patients were offered nevirapine-based triple ART initiated in pregnancy until 6 months postpartum. Main outcome measures were maternal mortality, abortion/stillbirth, prematurity, and low birth weight. Results: Maternal mortality was 1.2% (42/3273): 7.4% in 68 women with no antenatal ART and 0.7% in 1370 with at least 90 days of antenatal ART [P <0.001; odds ratio (OR) 0.29 (95% confidence interval [CI] 0.14-0.96]. Abortion/stillbirth was 5.2% (169/3273): 26.5% in 68 women with no ART and 5.0% in 1370 women with at least 90 days of antenatal ART [P <0.001; OR 0.39 (95% CI 0.27-0.57)]. Prematurity was 19.1%: 70% in 10 women with no antenatal ART and 8.5% in 1330 women with at least 90 days of antenatal ART [P <0.001; OR 0.15 (95% CI 0.14-0.19)]. Low birth weight was 11.5% (57/496) and not associated with ART duration. The protective effect of antenatal ART against mortality, fetal demise, and prematurity was independent of CD4 strata. Multivariate analysis for BMI, CD4 cell count, virus load, days in care, predelivery length of ART, and hemoglobin demonstrated an independent association between predelivery length of ART and CD4 with maternal mortality, abortion/stillbirth, and prematurity. ART toxicities were infrequent (5.2%). Conclusion: Antenatal triple ART reduces adverse pregnancy outcomes in HIV-infected women.

Original languageEnglish
Pages (from-to)1611-1618
Number of pages8
JournalAIDS (London, England)
Volume25
Issue number13
DOIs
Publication statusPublished - Aug 24 2011

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Pregnancy Outcome
HIV-1
Mothers
Therapeutics
Stillbirth
Maternal Mortality
Odds Ratio
HIV
Low Birth Weight Infant
Confidence Intervals
Mozambique
Nevirapine
Malawi
Fetal Death
Prenatal Care
CD4 Lymphocyte Count
Malnutrition
Postpartum Period
Acquired Immunodeficiency Syndrome
Hemoglobins

Keywords

  • HIV in pregnancy
  • pregnancy and antiretroviral
  • pregnancy outcomes
  • prevention of mother-to-child-transmission

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes. / Marazzi, Maria C.; Palombi, Leonardo; Nielsen-Saines, Karin; Haswell, Jere; Zimba, Ines; Magid, Nurja A.; Buonomo, Ersilia; Scarcella, Paola; Ceffa, Susanna; Paturzo, Giovanna; Narciso, Pasquale; Liotta, Giuseppe.

In: AIDS (London, England), Vol. 25, No. 13, 24.08.2011, p. 1611-1618.

Research output: Contribution to journalArticle

Marazzi, MC, Palombi, L, Nielsen-Saines, K, Haswell, J, Zimba, I, Magid, NA, Buonomo, E, Scarcella, P, Ceffa, S, Paturzo, G, Narciso, P & Liotta, G 2011, 'Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes', AIDS (London, England), vol. 25, no. 13, pp. 1611-1618. https://doi.org/10.1097/QAD.0b013e3283493ed0
Marazzi, Maria C. ; Palombi, Leonardo ; Nielsen-Saines, Karin ; Haswell, Jere ; Zimba, Ines ; Magid, Nurja A. ; Buonomo, Ersilia ; Scarcella, Paola ; Ceffa, Susanna ; Paturzo, Giovanna ; Narciso, Pasquale ; Liotta, Giuseppe. / Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes. In: AIDS (London, England). 2011 ; Vol. 25, No. 13. pp. 1611-1618.
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abstract = "Objective: To evaluate pregnancy outcomes in a cohort of HIV-infected women receiving triple antiretroviral therapy (ART) for prevention of mother-to-child-transmission. Methods: A retrospective cohort study with review of records of 3273 HIV-positive women receiving prenatal care in Malawi and Mozambique from July 2005 to December 2009 was conducted in Drug Resource Enhancement Against AIDS and Malnutrition (DREAM) centers. Patients were offered nevirapine-based triple ART initiated in pregnancy until 6 months postpartum. Main outcome measures were maternal mortality, abortion/stillbirth, prematurity, and low birth weight. Results: Maternal mortality was 1.2{\%} (42/3273): 7.4{\%} in 68 women with no antenatal ART and 0.7{\%} in 1370 with at least 90 days of antenatal ART [P <0.001; odds ratio (OR) 0.29 (95{\%} confidence interval [CI] 0.14-0.96]. Abortion/stillbirth was 5.2{\%} (169/3273): 26.5{\%} in 68 women with no ART and 5.0{\%} in 1370 women with at least 90 days of antenatal ART [P <0.001; OR 0.39 (95{\%} CI 0.27-0.57)]. Prematurity was 19.1{\%}: 70{\%} in 10 women with no antenatal ART and 8.5{\%} in 1330 women with at least 90 days of antenatal ART [P <0.001; OR 0.15 (95{\%} CI 0.14-0.19)]. Low birth weight was 11.5{\%} (57/496) and not associated with ART duration. The protective effect of antenatal ART against mortality, fetal demise, and prematurity was independent of CD4 strata. Multivariate analysis for BMI, CD4 cell count, virus load, days in care, predelivery length of ART, and hemoglobin demonstrated an independent association between predelivery length of ART and CD4 with maternal mortality, abortion/stillbirth, and prematurity. ART toxicities were infrequent (5.2{\%}). Conclusion: Antenatal triple ART reduces adverse pregnancy outcomes in HIV-infected women.",
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AU - Haswell, Jere

AU - Zimba, Ines

AU - Magid, Nurja A.

AU - Buonomo, Ersilia

AU - Scarcella, Paola

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N2 - Objective: To evaluate pregnancy outcomes in a cohort of HIV-infected women receiving triple antiretroviral therapy (ART) for prevention of mother-to-child-transmission. Methods: A retrospective cohort study with review of records of 3273 HIV-positive women receiving prenatal care in Malawi and Mozambique from July 2005 to December 2009 was conducted in Drug Resource Enhancement Against AIDS and Malnutrition (DREAM) centers. Patients were offered nevirapine-based triple ART initiated in pregnancy until 6 months postpartum. Main outcome measures were maternal mortality, abortion/stillbirth, prematurity, and low birth weight. Results: Maternal mortality was 1.2% (42/3273): 7.4% in 68 women with no antenatal ART and 0.7% in 1370 with at least 90 days of antenatal ART [P <0.001; odds ratio (OR) 0.29 (95% confidence interval [CI] 0.14-0.96]. Abortion/stillbirth was 5.2% (169/3273): 26.5% in 68 women with no ART and 5.0% in 1370 women with at least 90 days of antenatal ART [P <0.001; OR 0.39 (95% CI 0.27-0.57)]. Prematurity was 19.1%: 70% in 10 women with no antenatal ART and 8.5% in 1330 women with at least 90 days of antenatal ART [P <0.001; OR 0.15 (95% CI 0.14-0.19)]. Low birth weight was 11.5% (57/496) and not associated with ART duration. The protective effect of antenatal ART against mortality, fetal demise, and prematurity was independent of CD4 strata. Multivariate analysis for BMI, CD4 cell count, virus load, days in care, predelivery length of ART, and hemoglobin demonstrated an independent association between predelivery length of ART and CD4 with maternal mortality, abortion/stillbirth, and prematurity. ART toxicities were infrequent (5.2%). Conclusion: Antenatal triple ART reduces adverse pregnancy outcomes in HIV-infected women.

AB - Objective: To evaluate pregnancy outcomes in a cohort of HIV-infected women receiving triple antiretroviral therapy (ART) for prevention of mother-to-child-transmission. Methods: A retrospective cohort study with review of records of 3273 HIV-positive women receiving prenatal care in Malawi and Mozambique from July 2005 to December 2009 was conducted in Drug Resource Enhancement Against AIDS and Malnutrition (DREAM) centers. Patients were offered nevirapine-based triple ART initiated in pregnancy until 6 months postpartum. Main outcome measures were maternal mortality, abortion/stillbirth, prematurity, and low birth weight. Results: Maternal mortality was 1.2% (42/3273): 7.4% in 68 women with no antenatal ART and 0.7% in 1370 with at least 90 days of antenatal ART [P <0.001; odds ratio (OR) 0.29 (95% confidence interval [CI] 0.14-0.96]. Abortion/stillbirth was 5.2% (169/3273): 26.5% in 68 women with no ART and 5.0% in 1370 women with at least 90 days of antenatal ART [P <0.001; OR 0.39 (95% CI 0.27-0.57)]. Prematurity was 19.1%: 70% in 10 women with no antenatal ART and 8.5% in 1330 women with at least 90 days of antenatal ART [P <0.001; OR 0.15 (95% CI 0.14-0.19)]. Low birth weight was 11.5% (57/496) and not associated with ART duration. The protective effect of antenatal ART against mortality, fetal demise, and prematurity was independent of CD4 strata. Multivariate analysis for BMI, CD4 cell count, virus load, days in care, predelivery length of ART, and hemoglobin demonstrated an independent association between predelivery length of ART and CD4 with maternal mortality, abortion/stillbirth, and prematurity. ART toxicities were infrequent (5.2%). Conclusion: Antenatal triple ART reduces adverse pregnancy outcomes in HIV-infected women.

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