Liver Enzyme Elevation in Pregnant Women Receiving Antiretroviral Therapy in the ANRS-French Perinatal Cohort

被引：10

作者：

Sibiude, Jeanne ^{[1
,2
]}

Warszawski, Josiane ^{[2
,3
]}

Tubiana, Roland ^{[4
,5
,6
,55
]}

Le Chenadec, Jerome ^{[2
]}

Meier, Francoise ^{[7
,13
]}

Faye, Albert ^{[8
,9
,69
]}

Blanche, Stephane ^{[10
,11
,51
]}

Mandelbrot, Laurent ^{[2
,9
,12
,13
]}

Crenn-Hebert, Catherine ^{[13
]}

Floch-Tudal, Corinne ^{[13
]}

Mazy, Fabienne ^{[13
]}

Joras, Marine ^{[13
]}

Mortier, Emmanuel ^{[13
]}

Briquet, Catherine ^{[13
]}

Ichou, Houria ^{[13
]}

Marty, Laurence ^{[13
]}

Ceccaldi, Pierre-Francois ^{[14
]}

Banige, Maia ^{[14
]}

Uludag, Agnes Villemant ^{[14
]}

Zarouk, Virginie ^{[14
]}

Lefort, Agnes ^{[14
]}

Ben Salah, Mariam ^{[14
]}

Hittinger, Gilles ^{[15
]}

Chamouilli, Jean-Marc ^{[15
]}

Burle, Christian ^{[15
]}

Lafeuillade, Alain ^{[15
]}

Philip, Gisele ^{[15
]}

Medus, Marie ^{[16
]}

Bachelard, Germaine ^{[16
]}

Malet, Martine ^{[16
]}

Dendale-Nguyen, Joelle ^{[17
]}

Guimard, Thomas ^{[18
]}

Guimard, Karine ^{[18
]}

Brossier, Jean-Pierre ^{[18
]}

Perre, Philippe ^{[18
]}

Esnault, Jean-Luc

Aubry, Olivier ^{[18
]}

Leautez-Nainville, Sophie ^{[18
]}

Bonnenfant, Valerie ^{[18
]}

Laine, Laeticia ^{[18
]}

Martha, Sandrine-Anne ^{[19
]}

Maurel, Elise ^{[19
]}

Francoise, Michel ^{[19
]}

Barat, Muriel ^{[19
]}

Murger, Patricia ^{[19
]}

Rouha, Mahfoud ^{[20
]}

Lumbroso, Philippe ^{[20
]}

Checoury, Alain ^{[20
]}

Sahadatu, Osseni ^{[20
]}

Johnson ^{[20
]}

机构：

[1] Hop Louis Mourier, AP HP, Dept Obstet & Gynecol, Colombes, France

[2] INSERM, U1018, Ctr Rech Epidemiol & Sante Populat, Dept Epidemiol, Le Kremlin Bicetre, France

[3] Univ Paris Sud, INED, Le Kremlin Bicetre, France

[4] GH Pitie Salpetriere, AP HP, Dept Infectiol, Paris, France

[5] UPMC Univ, Sorbonne Univ, Paris, France

[6] Pierre Louis Inst Epidemiol & Publ Hlth, INSERM, UMR S 1136, Paris, France

[7] Hop Louis Mourier, AP HP, Dept Infectiol, Colombes, France

[8] Hop Robert Debre, AP HP, Dept Pediat, Paris, France

[9] Univ Diderot Paris 7, Paris, France

[10] Hop Necker Enfants Malad, Dept Pediat, F-75015 Paris, France

[11] Univ Paris Descartes 5, EA 7223 Evaluat Therapeut & Pharmacol Perinatale, F-75006 Paris, France

[12] Hop Louis Mourier, AP HP, Dept Obstet & Gynecol, Colombes, France

[13] Hop Louis Mourier, AP HP, Colombes, France

[14] Hop Beaujon, AP HP, Clichy, France

[15] Hop Sainte Musse, Toulon, France

[16] CHG Marechal Joffre, Perpignan, France

[17] CHU Caremeau, Nimes, France

[18] CHD Oudairies, La Roche Sur Yon, France

[19] Ctr Hosp William Morey, Chalon Sur Saone, France

[20] Ctr Hosp, Vernon, France

[21] Ctr Hosp Intercommunal Cornouaille, Quimper, France

[22] CHU Brest, Brest, France

[23] Ctr Hosp, St Brieuc, France

[24] CHU Rennes, Rennes, France

[25] Ctr Hosp Bretagne Atlant, Vannes, France

[26] Ctr Hosp Bretagne Sud, Lorient, France

[27] Ctr Hosp Reg Annecy, Annecy, France

[28] Ctr Hosp Intercommunal, Montfermeil, France

[29] Ctr Hosp Intercommunal, Montreuil, France

[30] Hop Cochin Port Royal, AP HP, Paris, France

[31] Hop Bichat Claude Bernard, AP HP, Paris, France

[32] Ctr Hosp Intercommunal, Creteil, France

[33] Hop Croix Rousse, Lyon, France

[34] Ctr Hosp Pellegrin, Bordeaux, France

[35] CHU Abymes, Pointe A Pitre, Guadeloupe, France

[36] Ctr Hosp Gen, Creil, France

[37] Hop Haute Pierre, Strasbourg, France

[38] Ctr Hosp Gen, Longjumeau, France

[39] Hop Paule Viguier, Toulouse, France

[40] Ctr Hosp Cote Basque, Bayonne, France

[41] Ctr Hosp Intercommunal, Villeneuve St Georges, France

[42] Ctr Hosp Intercommunal, Poissy St Germain Laye, France

[43] Ctr Hosp Gen, Fontainebleau, France

[44] Ctr Hosp Robert Ballanger, Aulnay Sous Bois, France

[45] Hop Hautepierre, Strasbourg, France

[46] Hop Civil, Strasbourg, France

[47] Ctr Medicochirurg Obstetr, Strasbourg, France

[48] Ctr Hosp Victor Dupouy, Argenteuil, France

[49] Hop Tenon, AP HP, Paris, France

[50] Ctr Hosp Gen, St Denis, Reunion, France

来源：

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES | 2019年 / 81卷 / 01期

关键词：

liver enzyme elevation; HIV; PMTCT; antiretroviral treatment; protease inhibitors; preterm birth; INCREASED RISK; MATERNAL TOXICITY; NEVIRAPINE USE; FUNCTION TESTS; HEPATOTOXICITY; PROTEASE; PROGESTERONE; TRANSMISSION; PREECLAMPSIA; CHOLESTASIS;

D O I：

10.1097/QAI.0000000000001963

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: High rates of liver enzyme elevation (LEE) in women receiving antiretroviral treatment (ART) during pregnancy have been reported, but causes remain unclear. We estimated the prevalence and risk factors of LEE in a national prospective multicenter cohort. Methods: We studied 5748 pregnant women living with HIV enrolled in the French Perinatal Cohort 2005-2014, treated with ART, with no active hepatitis B or C coinfection. Adjusted hazard ratio (aHR) was estimated using Cox models with ART as time-dependent variable, separately for women on ART at conception and those initiating ART during pregnancy. Results: LEE (grade >= 1) was observed in 16.7%, grade 3-4 in 2%. Among women with LEE, 6.7% had pre-eclampsia, 9.8% intrahepatic cholestasis of pregnancy, and 1.4% other identified medical causes. Most LEEs (82.2%) were unexplained. In women with unexplained LEE, LEE was the reason for hospitalization in 51 (6%) women, cesarean section in 13 (2%), induction of labor in 3 (0.4%), and change in ART regimen in 49 (6%) women. Unexplained LEE was associated with higher risk of preterm births, P < 0.001. Among women on ART at conception, the risk of unexplained LEE was lower with NNRTI-based regimens than with PI-based regimens: aHR = 0.5 (0.3-0.7), with no difference among the PI-drugs. Most women initiating ART during pregnancy were on a PI-based regimen (89%). Among them, LEE was less frequent for women on nelfinavir vs. lopinavir/r [aHR = 0.4 (0.2-0.8)]. Conclusions: Rates of LEE among pregnant women living with HIV are high and impact obstetrical care management. The possible role of PIs needs further investigation.

引用

页码：83 / 94

页数：12

共 42 条

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