Triple Antiretroviral Therapy Effective, Safe in Pregnancy


TORONTO — Triple antiretroviral therapy during pregnancy was effective for preventing vertical transmission of HIV to newborns, and was not associated with an increased risk of prematurity, significant growth abnormalities, or malformations in a retrospective cohort of 206 mother-infant pairs, Dr. Sophie Alloul reported in a poster at the annual meeting of the Pediatric Academic Societies.

Nucleoside and nucleotide analogue reverse transcriptase inhibitors were used in 205 (99.5%) mothers, protease inhibitors in 177 (86%), nonnucleoside reverse transcriptase inhibitors in 40 (19%), and zidovudine during labor in 202 (98%). Nelfinavir (Viracept) was the most commonly used protease inhibitor. Most women were treated for a median of 20 weeks before delivery. Among newborns, 97% received a 6-week regimen of zidovudine, lamivudine, and nelfinavir from birth.

The transmission rate in the cohort was 0.5%, with only one infant contracting HIV during the study period of 1997–2005, said Dr. Alloul and her colleagues at Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal.

The average gestational age was 38 weeks, and there was one stillbirth. The prevalence of prematurity was 8.5%, and premature infants' median weight was 2,257 g.

Term neonates had a median birth weight of 3,200 g, and 10.3% were small for gestational age (SGA), with a mean weight of 2,208 g. In all, 29 (14%) infants presented with minor malformations.

When compared with a control group of 91 newborns from noninfected, nontreated mothers, the prevalences of prematurity, SGA, and malformations were not significantly different, the authors said.

Centers for Disease Control and Prevention growth parameters—including weight, length, and head circumference—were all within normal range during the first 2 years of life for infants born to treated mothers.

The findings are reassuring, inasmuch as recent data suggest that the use of protease inhibitors is correlated with an increased rate of prematurity in newborns, Dr. Alloul said in an interview.

Triple therapy is now standard of care at CHU Sainte-Justine for all HIV-infected mothers and their offspring, she said.

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