Abstract
Background:Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. In addition, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized.Methods:We studied WLHIV with ≥2 live-born infants enrolled into the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for Antiretroviral Treatment Toxicities (SMARTT) study between 2007 and 2018, comparing CD4 counts and viral loads (VLs) between 2 consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression and the association of PI/INSTI use during pregnancy with odds of preterm birth.Results:There were 736 women who had ≥2 live-born children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. Although >80% of women achieved VL suppression during pregnancy, more than half had a detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with first trimester PI initiation (adjusted odds ratio: 1.97; 95% confidence interval: 1.27 to 3.07) compared with those not receiving PIs during pregnancy and for first trimester INSTI initiation (adjusted odds ratio: 2.39; 95% confidence interval: 1.04 to 5.46) compared with those never using INSTIs during pregnancy.Conclusions:Most WLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with a higher risk of preterm birth.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 346-354 |
| Number of pages | 9 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 85 |
| Issue number | 3 |
| DOIs | |
| State | Published - Nov 1 2020 |
Funding
The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). Authors P.L.W., Y.H., and D.K. receive grant funding from NIH grant HD052102. L.B.H., L.M.Y., E.G.C., K.M.P., and R.B.V.D. receive grant funding from the coordinating center grant NIH HD052104. L.M.Y. was supported by the NICHD K12 HD050121-11 at the time of the study. The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services. The authors thank the women and families for their participation in PHACS and the individuals and institutions involved in the conduct of PHACS. The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Institute of Dental and Craniofacial Research, the National Cancer Institute, the National Institute on Alcohol Abuse and Alcoholism, the Office of AIDS Research, and the National Heart, Lung, and Blood Institute through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) (Principal Investigator: George R Seage III; Program Director: Liz Salomon) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigator: E.G.C.; Project Director: Patrick Davis). Data management services were provided by the Frontier Science and Technology Research Foundation (PI: Suzanne Siminski), and regulatory services and logistical support were provided by Westat, Inc. (PI: Julie Davidson). The following institutions, clinical site investigators, and staff participated in conducting PHACS SMARTT in 2018, in alphabetical order: Ann and Robert H. Lurie Children's Hospital of Chicago: E.G.C., Margaret Ann Sanders, Kathleen Malee, and Scott Hunter; Baylor College of Medicine: William Shearer, Mary Paul, Chivon McMullen-Jackson, Ruth Eser-Jose, and Lynnette Harris; Bronx Lebanon Hospital Center: Murli Purswani, Mahoobullah Mirza Baig, and Alma Villegas; Children's Diagnostic and Treatment Center: Lisa Gaye-Robinson, Jawara Dia Cooley, James Blood, and Patricia Garvie; New York University School of Medicine: William Borkowsky, Sandra Deygoo, and Jennifer Lewis; Rutgers—New Jersey Medical School: Arry Dieudonne, Linda Bettica, Juliette Johnson, and Karen Surowiec; St. Jude Children's Research Hospital: Katherine Knapp, Kim Allison, Megan Wilkins, and Jamie Russell-Bell; San Juan Hospital/Department of Pediatrics: Nicolas Rosario, Lourdes Angeli-Nieves, and Vivian Olivera; SUNY Downstate Medical Center: Stephan Kohlhoff, Ava Dennie, and Jean Kaye; Tulane University School of Medicine: Russell Van Dyke, Karen Craig, and Patricia Sirois; University of Alabama, Birmingham: Cecelia Hutto, Paige Hickman, and Dan Marullo; University of California, San Diego: Stephen A. Spector, Veronica Figueroa, Megan Loughran, and Sharon Nichols; University of Colorado, Denver: Elizabeth McFarland, Emily Barr, Christine Kwon, and Carrie Glenny; University of Florida, Center for HIV/AIDS Research, Education and Service: Mobeen Rathore, Kristi Stowers, Saniyyah Mahmoudi, Nizar Maraqa, and Rosita Almira; University of Illinois, Chicago: Karen Hayani, Lourdes Richardson, Renee Smith, and Alina Miller; University of Miami: Gwendolyn Scott, Maria Mogollon, Gabriel Fernandez, and Anai Cuadra; Keck Medicine of the University of Southern California: Toni Frederick, Mariam Davtyan, Jennifer Vinas, and Guadalupe Morales-Avendano; University of Puerto Rico School of Medicine, Medical Science Campus: Zoe M. Rodriguez, Lizmarie Torres, and Nydia Scalley.
Keywords
- HIV
- antiretrovirals
- pregnancy
- preterm birth
ASJC Scopus subject areas
- Infectious Diseases
- Pharmacology (medical)
