Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy.

TitlePregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy.
Publication TypeJournal Article
Year of Publication2018
AuthorsStringer EM, Kendall MA, Lockman S, Campbell TB, Nielsen-Saines K, Sawe F, Cu-Uvin S, Wu X, Currier JS
JournalPLoS One
Volume13
Issue7
Paginatione0199555
Date Published2018
ISSN1932-6203
KeywordsAdult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Female, HIV Infections, Humans, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Premature Birth, Proportional Hazards Models, Stillbirth, United States
Abstract

As antiretroviral therapy (ART) expands in resource-limited settings, understanding the impact of ART on pregnancy outcomes is critical. We analyzed women who became pregnant on ART while enrolled in a clinical trial (HPTN 052, ACTG A5208, and ACTG A5175); the majority of women were from Africa, with a median age of 29 years. Eligible women were on ART at conception and had a documented date of a last menstrual period and a pregnancy outcome. The primary outcome was non-live birth (stillbirth; spontaneous abortion; elective termination; or ectopic pregnancy) versus live birth. Preterm birth (<37 weeks completed gestation) was a secondary outcome. We used Cox proportional hazards regression models with time-varying covariates. 359 women became pregnant, of whom 253 (70%) met inclusion criteria: 127 (50%) were on NNRTI-based ART, 118 (47%) on PI-based ART, and 8 (3%) on 3-NRTIs at conception. There were 160 (63%) live births (76 term and 84 preterm), 11 (4%) stillbirths, 51 (20%) spontaneous abortions, 28 (11%) elective terminations, and 3 (1%) ectopic pregnancies. In multivariable analysis adjusted for region, parent study, and pre-pregnancy ART class, only older age was associated with increased hazard of preterm birth [HR: 2.49 for age 25-30 years; 95% CI: 1.18-5.26; p = 0.017]. Women conceiving on ART had high rates of preterm birth and other adverse pregnancy outcomes. Despite the benefits of ART, studies designed to investigate the effects of preconception ART on pregnancy outcomes are needed.

DOI10.1371/journal.pone.0199555
Alternate JournalPLoS ONE
PubMed ID30020964
PubMed Central IDPMC6051581
Grant ListUM1 AI069424 / AI / NIAID NIH HHS / United States
UM1 AI069456 / AI / NIAID NIH HHS / United States
UM1 AI069432 / AI / NIAID NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States
U01 AI069424 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
U01 AI068619 / AI / NIAID NIH HHS / United States
UM1 AI068619 / AI / NIAID NIH HHS / United States