Modern antiretroviral regimens in pregnant women: virologic outcomes and durability.

Creator(s)

Christiana Smith
Lori Silveira
Megan Crotteau
Krystle Garth
Jennifer Canniff
Kirk B. Fetters
Sarah Lazarus
Shannon Capraro, Children's Mercy Kansas CityFollow
Adriana Weinberg
CHIP Perinatal Team

Document Type

Article

Publication Date

1-1-2024

Identifier

DOI: 10.1097/QAD.0000000000003616

Abstract

OBJECTIVES: Data are lacking on the virologic efficacy and durability of modern antiretroviral treatment (ART) regimens during pregnancy. We compared virologic outcomes at delivery among women receiving dolutegravir versus other ART and the rate of change of the initial pregnancy regimen.

DESIGN: Single-site retrospective cohort between 2009 and 2019.

METHODS: We used univariable and multivariable generalized estimating equations to model the relationship between the maternal ART anchor and the proportion of women with a detectable viral load (greater than or equal to 20 HIV RNA copies/mL of plasma) closest to delivery (suboptimal virologic control) and with a detectable viral load at any time in the third trimester. We also compared changes in ART during pregnancy.

RESULTS: We evaluated 230 pregnancies in 173 mothers. Rates of optimal virologic control at delivery did not significantly differ in mothers who received dolutegravir (93.1%), rilpivirine (92.1%), boosted darunavir (82.6%), or efavirenz (76.9%) but were significantly lower among mothers receiving atazanavir (49.0%) or lopinavir (40.9%). The odds of having a detectable viral load at any time in the third trimester was also higher for atazanavir and lopinavir. Raltegravir, elvitegravir, or bictegravir were used in less than 10 mothers at delivery, which precluded statistical analyses. The frequency of change in ART was significantly higher in mothers who initially received elvitegravir (68%) or efavirenz (47%) than dolutegravir (18%).

CONCLUSION: Dolutegravir-containing, rilpivirine-containing, and boosted darunavir-containing regimens conferred excellent virologic control in pregnancy. Atazanavir and lopinavir, elvitegravir, and efavirenz were associated with either high rates of virologic failure or regimen change during pregnancy.

Journal Title

AIDS (London, England)

Volume

38

Issue

1

First Page

21

Last Page

29

Recommended Citation

Smith C, Silveira L, Crotteau M, et al. Modern antiretroviral regimens in pregnant women: virologic outcomes and durability. AIDS. 2024;38(1):21-29. doi:10.1097/QAD.0000000000003616