Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception

被引:12
作者
Huntington, Susie E. [1 ,2 ]
Bansi, Loveleen K.
Thorne, Claire [2 ]
Anderson, Jane [3 ]
Newell, Marie-Louise [2 ,4 ]
Taylor, Graham P. [5 ]
Pillay, Deenan [6 ]
Hill, Teresa
Tookey, Pat A. [2 ]
Sabin, Caroline A.
机构
[1] UCL Med Sch, Res Dept Infect & Populat Hlth, London NW3 2PF, England
[2] UCL, UCL Inst Child Hlth, MRC Ctr Epidemiol Child Hlth, London WC1E 6BT, England
[3] Homerton Univ, Hosp NHS Fdn Trust, London, England
[4] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Durban, South Africa
[5] St Marys Hosp, Imperial Coll Healthcare NHS Trust, London, England
[6] Hlth Protect Agcy, Ctr Infect, London, England
基金
英国惠康基金; 英国医学研究理事会;
关键词
antiretroviral agents; antiretroviral therapy; HIV; pregnancy; United Kingdom; INFECTED WOMEN; ASSOCIATION GUIDELINES; EXPOSURE; IRELAND; MANAGEMENT; ADHERENCE; EFAVIRENZ; OUTCOMES; TRENDS; RATES;
D O I
10.1097/QAD.0b013e32834982af
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objectives: To describe antiretroviral therapy (ART) use and clinical status, at start of and during pregnancy, for HIV-positive women receiving ART at conception, including the proportion conceiving on drugs (efavirenz and didanosine) not recommended for use in early pregnancy. Methods: Women with a pregnancy resulting in a live-birth after 1995 (n = 1537) were identified in an observational cohort of patients receiving HIV care at 12 clinics in the UK by matching records with national pregnancy data. Treatment and clinical data were analysed for 375 women conceiving on ART, including logistic regression to identify factors associated with changing regimen during pregnancy. Results: Of the 375 women on ART, 39 (10%) conceived on dual therapy, 306 (82%) on triple therapy and 30 (8%) on more than three drugs. In total, 116 (31%) women conceived on a regimen containing efavirenz or didanosine (69 efavirenz, 54 didanosine, seven both). Overall, 38% (143) changed regimen during pregnancy, of whom 44% (n = 51) had a detectable viral load around that time. Detectable viral load was associated with increased risk of regimen change [adjusted odds ratio 2.97, 95% confidence interval (CI) (1.70-5.19)], while women on efavirenz at conception were three times more likely to switch than women on other drugs [3.40, (1.84-6.25)]. Regimen switching was also associated with year at conception [0.89, (0.83-0.96)]. Conclusion: These findings reinforce the need for careful consideration of ART use among women planning or likely to have a pregnancy in order to reduce viral load before pregnancy and avoid drugs not recommended for early antenatal use. (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
引用
收藏
页码:1647 / 1655
页数:9
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