alexa Increased rate of prematurity associated with antenatal antiretroviral therapy in a German Austrian cohort of HIV-1-infected women.


Journal of Antivirals & Antiretrovirals

Author(s): GroschWoerner I, Puch K, Maier RF, Niehues T, Notheis G,

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Abstract OBJECTIVE: The aim of the study was to assess the risk of adverse pregnancy outcomes after antenatal antiretroviral therapy in a well-defined prospective cohort of nontransmitting HIV-infected women. METHODS: Prospective monitoring of 183 mother-child pairs from 13 centres in Germany and Austria, delivering between 1995 and 2001, was carried out. Following German-Austrian guidelines recommending an elective Caesarean section (CS) at 36 weeks, prematurity was defined as <36 weeks' gestation for these analyses. RESULTS: Of 183 mother-child pairs, 42\% were exposed to antenatal monotherapy and 17\% to dual therapy. Of the 75 women exposed to highly active antiretroviral therapy (HAART), 21 (28\%) received protease inhibitor (PI)-based HAART and the remaining 54 received nonnucleoside reverse transcriptase inhibitor-based HAART. In multivariable analysis (176 pregnancies), PI-based HAART exposure during pregnancy was associated with an increased risk of premature delivery [adjusted odds ratio 3.40; 95\% confidence interval (CI) 1.13-10.2; P=0.029, compared with monotherapy]. Congenital abnormalities affected 3.3\% infants. Perinatally, 18.9\% of children (34 of 179) had respiratory problems requiring interventions, which were associated with prematurity but not with type of treatment exposure. From adjusted regression analysis, the mean birth weight z-score for children exposed to HAART with PI (+0.46; 95\% CI 0.01-0.92; P=0.047) or dual therapy (+0.43; 95\% CI 0.03-0.82; P=0.034) was slightly but significantly higher than that for those exposed to monotherapy; head circumference was appropriate for gestational age and there were no significant differences between treatment groups. CONCLUSIONS: Use of antenatal PI-based HAART initiated before or during pregnancy was associated with a significantly increased risk of premature delivery at <36 weeks' gestation. The overall crude prematurity rate was 34\% (63 of 183; 95\% CI 28-42). This article was published in HIV Med and referenced in Journal of Antivirals & Antiretrovirals

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