Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors: an observational study

The Italian Group on Surveillance of Antiretroviral Treatment in Pregnancy

Research output: Contribution to journalArticle

Abstract

Purpose: Recommended regimens for pregnant women with HIV-1 are composed of two nucleoside reverse transcriptase inhibitors (NRTI) plus either a ritonavir-boosted protease inhibitor (PI) or an integrase strand transfer inhibitor (ISTI), with non-nucleoside reverse transcriptase inhibitors (NNRTI) representing an alternative drug class. The study’s purpose was to compare these three options in terms of pregnancy outcomes. Methods: Data from a national observational study of pregnant women with HIV-1 were used. The analysis included all pregnancies reported between 2008 and 2018, ending in live births and exposed within 32 weeks of gestation to three-drug regimens composed of a NRTI backbone plus a PI, a NNRTI or a ISTI, without class switching during pregnancy. Clinical and laboratory outcomes were evaluated in univariate and multivariable analyses. Results: Overall, 794 exposed pregnancies were analyzed (PI 78.4%, NNRTI 15.4%, ISTI 6.2%). Almost all outcomes had similar rates in the three groups. Women who received PI in pregnancy were less likely to be virologically suppressed at third trimester. PI use was associated with higher bilirubin and triglyceride levels, and ISTI use with a lower rate of low birthweight. The differences in viral suppression at third trimester and in low birthweight were not maintained in multivariable analyses that were adjusted for confounders. Discussion: We found no major differences in a wide range of outcomes relevant for pregnant women with HIV. Such results are reassuring, and this information may be helpful in a context of preconception counseling when therapeutic choices for pregnancy are discussed between women and care providers.

Original languageEnglish
JournalInfection
DOIs
Publication statusAccepted/In press - Jan 1 2020

Fingerprint

Integrase Inhibitors
Reverse Transcriptase Inhibitors
Pregnancy Outcome
Protease Inhibitors
Observational Studies
HIV-1
Integrases
Pregnancy
Pregnant Women
Third Pregnancy Trimester
Nucleosides
Immunoglobulin Class Switching
Ritonavir
Live Birth
Bilirubin
Pharmaceutical Preparations
Counseling
Triglycerides
HIV

Keywords

  • Delivery complications
  • HIV
  • HIV suppression
  • Low birthweight
  • Pregnancy
  • Preterm delivery

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors : an observational study. / The Italian Group on Surveillance of Antiretroviral Treatment in Pregnancy.

In: Infection, 01.01.2020.

Research output: Contribution to journalArticle

@article{a0bdfb7100724da7883379c1c4ef0b74,
title = "Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors: an observational study",
abstract = "Purpose: Recommended regimens for pregnant women with HIV-1 are composed of two nucleoside reverse transcriptase inhibitors (NRTI) plus either a ritonavir-boosted protease inhibitor (PI) or an integrase strand transfer inhibitor (ISTI), with non-nucleoside reverse transcriptase inhibitors (NNRTI) representing an alternative drug class. The study’s purpose was to compare these three options in terms of pregnancy outcomes. Methods: Data from a national observational study of pregnant women with HIV-1 were used. The analysis included all pregnancies reported between 2008 and 2018, ending in live births and exposed within 32 weeks of gestation to three-drug regimens composed of a NRTI backbone plus a PI, a NNRTI or a ISTI, without class switching during pregnancy. Clinical and laboratory outcomes were evaluated in univariate and multivariable analyses. Results: Overall, 794 exposed pregnancies were analyzed (PI 78.4{\%}, NNRTI 15.4{\%}, ISTI 6.2{\%}). Almost all outcomes had similar rates in the three groups. Women who received PI in pregnancy were less likely to be virologically suppressed at third trimester. PI use was associated with higher bilirubin and triglyceride levels, and ISTI use with a lower rate of low birthweight. The differences in viral suppression at third trimester and in low birthweight were not maintained in multivariable analyses that were adjusted for confounders. Discussion: We found no major differences in a wide range of outcomes relevant for pregnant women with HIV. Such results are reassuring, and this information may be helpful in a context of preconception counseling when therapeutic choices for pregnancy are discussed between women and care providers.",
keywords = "Delivery complications, HIV, HIV suppression, Low birthweight, Pregnancy, Preterm delivery",
author = "{The Italian Group on Surveillance of Antiretroviral Treatment in Pregnancy} and Marco Floridia and Serena Dalzero and Vania Giacomet and Enrica Tamburrini and Giulia Masuelli and Valeria Savasi and Arsenio Spinillo and Beatrice Tassis and Laura Franceschetti and {Degli Antoni}, {Anna Maria} and Matilde Sansone and Giovanni Guaraldi and Antonella Vimercati and Alessandra Meloni and Marina Ravizza",
year = "2020",
month = "1",
day = "1",
doi = "10.1007/s15010-019-01384-5",
language = "English",
journal = "Infection",
issn = "0300-8126",
publisher = "Urban und Vogel GmbH",

}

TY - JOUR

T1 - Pregnancy and neonatal outcomes in women with HIV-1 exposed to integrase inhibitors, protease inhibitors and non-nucleoside reverse transcriptase inhibitors

T2 - an observational study

AU - The Italian Group on Surveillance of Antiretroviral Treatment in Pregnancy

AU - Floridia, Marco

AU - Dalzero, Serena

AU - Giacomet, Vania

AU - Tamburrini, Enrica

AU - Masuelli, Giulia

AU - Savasi, Valeria

AU - Spinillo, Arsenio

AU - Tassis, Beatrice

AU - Franceschetti, Laura

AU - Degli Antoni, Anna Maria

AU - Sansone, Matilde

AU - Guaraldi, Giovanni

AU - Vimercati, Antonella

AU - Meloni, Alessandra

AU - Ravizza, Marina

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Purpose: Recommended regimens for pregnant women with HIV-1 are composed of two nucleoside reverse transcriptase inhibitors (NRTI) plus either a ritonavir-boosted protease inhibitor (PI) or an integrase strand transfer inhibitor (ISTI), with non-nucleoside reverse transcriptase inhibitors (NNRTI) representing an alternative drug class. The study’s purpose was to compare these three options in terms of pregnancy outcomes. Methods: Data from a national observational study of pregnant women with HIV-1 were used. The analysis included all pregnancies reported between 2008 and 2018, ending in live births and exposed within 32 weeks of gestation to three-drug regimens composed of a NRTI backbone plus a PI, a NNRTI or a ISTI, without class switching during pregnancy. Clinical and laboratory outcomes were evaluated in univariate and multivariable analyses. Results: Overall, 794 exposed pregnancies were analyzed (PI 78.4%, NNRTI 15.4%, ISTI 6.2%). Almost all outcomes had similar rates in the three groups. Women who received PI in pregnancy were less likely to be virologically suppressed at third trimester. PI use was associated with higher bilirubin and triglyceride levels, and ISTI use with a lower rate of low birthweight. The differences in viral suppression at third trimester and in low birthweight were not maintained in multivariable analyses that were adjusted for confounders. Discussion: We found no major differences in a wide range of outcomes relevant for pregnant women with HIV. Such results are reassuring, and this information may be helpful in a context of preconception counseling when therapeutic choices for pregnancy are discussed between women and care providers.

AB - Purpose: Recommended regimens for pregnant women with HIV-1 are composed of two nucleoside reverse transcriptase inhibitors (NRTI) plus either a ritonavir-boosted protease inhibitor (PI) or an integrase strand transfer inhibitor (ISTI), with non-nucleoside reverse transcriptase inhibitors (NNRTI) representing an alternative drug class. The study’s purpose was to compare these three options in terms of pregnancy outcomes. Methods: Data from a national observational study of pregnant women with HIV-1 were used. The analysis included all pregnancies reported between 2008 and 2018, ending in live births and exposed within 32 weeks of gestation to three-drug regimens composed of a NRTI backbone plus a PI, a NNRTI or a ISTI, without class switching during pregnancy. Clinical and laboratory outcomes were evaluated in univariate and multivariable analyses. Results: Overall, 794 exposed pregnancies were analyzed (PI 78.4%, NNRTI 15.4%, ISTI 6.2%). Almost all outcomes had similar rates in the three groups. Women who received PI in pregnancy were less likely to be virologically suppressed at third trimester. PI use was associated with higher bilirubin and triglyceride levels, and ISTI use with a lower rate of low birthweight. The differences in viral suppression at third trimester and in low birthweight were not maintained in multivariable analyses that were adjusted for confounders. Discussion: We found no major differences in a wide range of outcomes relevant for pregnant women with HIV. Such results are reassuring, and this information may be helpful in a context of preconception counseling when therapeutic choices for pregnancy are discussed between women and care providers.

KW - Delivery complications

KW - HIV

KW - HIV suppression

KW - Low birthweight

KW - Pregnancy

KW - Preterm delivery

UR - http://www.scopus.com/inward/record.url?scp=85077210357&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077210357&partnerID=8YFLogxK

U2 - 10.1007/s15010-019-01384-5

DO - 10.1007/s15010-019-01384-5

M3 - Article

AN - SCOPUS:85077210357

JO - Infection

JF - Infection

SN - 0300-8126

ER -