Is the interruption of antiretroviral treatment during pregnancy an additional major risk factor for mother-to-child transmission of HIV Type 1?

Luisa Galli, Donella Puliti, Elena Chiappini, Clara Gabiano, Gabriele Ferraris, Federica Mignone, Alessandra Viganò, Carlo Giaquinto, Orazio Genovese, Gianfranco Anzidei, Raffaele Badolato, Wilma Buffolano, Anna Maccabruni, Filippo Salvini, Monica Cellini, Maurizio Ruggeri, Mariano Manzionna, Stefania Bernardi, Pierangelo Tovo, F. De BenedictisP. Osimani, D. La Rovere, M. Quercia, M. Ruggeri, F. Baldi, M. Ciccia, A. Faldella, M. Masi, A. Plebani, E. Spinelli, M. Dedoni, D. Gariel, P. Chiarello, M. G. Magnolia, M. Sticca, L. Vivalda, T. Bezzi, E. Fiumana, L. Bianchi, N. Battiglia, P. Gervaso, E. Bondi, D. Cosso, C. Gotta, L. Ginocchio, R. Rosso, C. Viscoli, C. Amoretti, S. Esposito, F. Farina, V. Giacomet, R. Lipreri, A. Plebani, E. Salvatici, S. Stucchi, G. Palazzi, P. Paolucci, G. De Luca, A. Giannattasio, F. Tancredi, L. Tarallo, O. Rampon, E. Dalle Nogare, A. Romano, M. Saitta, B. Mariani, P. Biver, R. Consolini, G. Palla, A. De Fanti, I. Dodi, M. Verna, G. Bove, A. M. Casadei, G. Castelli Gattinara, S. Catania, A. M. Martino, M. M. Sirufo, A. Ganau, L. Cristiano, C. Scolfaro, A. Versace, V. Portelli, L. Gentilini, A. Mazza, M. Bernardon, J. Bua, M. Rabusin, A. Pellegatta, P. Fortunati, Maurizio de Martino

Research output: Contribution to journalArticlepeer-review

Abstract

Background. There is currently an experts' agreement discouraging interruption of antiretroviral treatment (ART) during the first trimester of pregnancy in women infected with human immunodeficiency virus type 1 (HIV-1). However, this recommendation is poorly supported by data. We evaluated the effects of discontinuing ART during pregnancy on the rate of mother-to-child transmission. Methods. Logistic regression models were performed in a prospective cohort of 937 children who were per- inatally exposed to HIV-1 to estimate adjusted odds ratios for confounding factors on mother-to-child transmission, including maternal interruption of ART. Results. Among 937 pregnant women infected with HIV-1, ART was interrupted in 81 (8.6%) in the first trimester and in 11 (1.2%) in the third trimester. In the first trimester, the median time at suspension of ART was 6 weeks (interquartile range [IQR], 5-6 weeks) and the time without treatment was 8 weeks (IQR, 7-11 weeks). In the third trimester, the median time at suspension of ART was 32 weeks (IQR, 23-36 weeks) and the time without treatment was 6 weeks (IQR, 2-9 weeks). The plasma viral load was similar in women who had treatment interrupted in the first trimester and in those who did not have treatment interrupted. Overall, the rate of mother-to-child transmission in the whole cohort was 1.3% (95% confidence interval [CI], 0.7%-2.3%), whereas it was 4.9% (95% CI, 1.9%-13.2%) when ART was interrupted in the first trimester and 18.2% (95% CI, 4.5%-72.7%) when ART was interrupted in the third trimester. In the multiple logistic regression models, only interruption of ART during either the first or the third trimester, maternal mono- or double therapy, delivery by a mode other than elective cesarean delivery, and a viral load at delivery >4.78 log10 copies/mL were independently associated with an increased rate of mother-to-child transmission. Conclusions. Discontinuing ART during pregnancy increases the rate of mother-to-child transmission of HIV- 1, either when ART is stopped in the first trimester and subsequently restarted or when it is interrupted in the third trimester. This finding supports recommendations to continue ART in pregnant women who are already receiving treatment for their health.

Original languageEnglish
Pages (from-to)1310-1317
Number of pages8
JournalClinical Infectious Diseases
Volume48
Issue number9
DOIs
Publication statusPublished - May 1 2009

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)
  • Medicine(all)

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