{"id":14271,"date":"2010-12-01T10:37:56","date_gmt":"2010-12-01T10:37:56","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=14271"},"modified":"2012-07-26T12:28:42","modified_gmt":"2012-07-26T12:28:42","slug":"high-preterm-delivery-rates-associated-with-initiation-of-haart-during-pregnancy-at-a-london-clinic","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/14271","title":{"rendered":"Highpreterm delivery rates associated with initiation of HAART during pregnancy at a London clinic"},"content":{"rendered":"

Polly Clayden, HIV i-Base<\/strong><\/p>\n

HAART use in pregnancy has been associated with preterm delivery (PTD) in some studies but not others.<\/p>\n

Graham Taylor and colleagues performed an analysis of pregnancies prospectively recorded at a London clinic between 1995 and 2010.<\/p>\n

This review included data for 331 deliveries. The majority of women were black African (78%) and infected through heterosexual intercourse (94%). Their median age was 32 years and median CD4 count 380 cells\/mm3. They attended their first antenatal appointment at a median of 13 weeks gestation. Of the group, only eight women took no antiretrovirals prior to delivery and seven took dual NNRTIs.<\/p>\n

The remaining women received HAART or prophylaxis, and are described in Table 1.<\/p>\n

The investigators reported 45\/331 PTD (13.6%) before 37 weeks gestation. Of these, 60% of deliveries were before 34 weeks. They observed no significant difference between women starting new continuous HAART (17.2%) and those already receiving HAART pre-conception (12.6%).<\/p>\n

They found a lower rate of PTD among women receiving nevirapine-based HAART to those receiving protease inhibitor-based HAART, which occurred in 16\/143 (11.2%) and 23\/103 (22.3%) respectively, p=0.02.<\/p>\n

They noted that 32 women receiving a short-course of HAART (START) during pregnancy to prevent mother- to-child HIV transmission would have been eligible, if they were willing to deliver by pre-labour caesarean section (PLCS), to receive AZT monotherapy, according to the 2008 BHIVA guidelines. Of these, 23 received PI based START and 39% (9\/23) had PTD events compared to 6.2% receiving AZT monotherapy, p=0.0005.<\/p>\n

The investigators acknowledged, \u0093The role of HAART and PI-based HAART in PTD has been controversial\u0094 and even in this single centre study \u0093confounders abound\u0094, despite all women being managed by one team in accordance with BHIVA guidelines.<\/p>\n

There was significant variation in CD4 counts and viral loads between women starting HAART in pregnancy and those taking AZT monotherapy or already receiving HAART at conception.<\/p>\n

They concluded that their data suggest that PI-based HAART initiated during pregnancy is associated with a significantly increased rate of PTD and that this is influenced by maternal immune status.<\/p>\n

They added that further investigation of the mechanism and impact of timing of antiretrovirals to optimise the safe use of this important intervention is overdue.<\/p>\n

Table 1. Rates of preterm delivery by treatment\/prophylaxis strategy <\/strong><\/p>\n\n\n\n\n\n\n\n
Treatment \/ prophylaxis <\/strong><\/td>\nN<\/strong><\/td>\nMedian CD4 (Baseline ANC)<\/strong><\/td>\nMedian viral load c\/mL<\/strong><\/td>\nPTD Number (%, 95% CI)<\/strong><\/td>\n<\/tr>\n
AZT monotherapy<\/td>\n65<\/td>\n460<\/td>\n2648<\/td>\n4 (6.2; 2.4-14.8)<\/td>\n<\/tr>\n
START<\/td>\n64<\/td>\n360<\/td>\n8930<\/td>\n15 (23.4; 14.7-35.1)<\/td>\n<\/tr>\n
New continuous HAART<\/td>\n58<\/td>\n150<\/td>\n23430<\/td>\n11 (19.6; 11.3-31.8)<\/td>\n<\/tr>\n
Pre-conception HAART<\/td>\n127<\/td>\n385<\/td>\n49<\/td>\n13 (9.6; 5.9-16.2)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

comment<\/h2>\n

The association between HAART and PTD continues to be demonstrated, particularly in European cohorts. <\/strong><\/p>\n

The investigators rightly stress that \u0093confounders abound\u0094 and that further investigation into the mechanism and how best to optimise strategies islong overdue.<\/strong><\/p>\n

Reference:<\/p>\n

Taylor G et al. High preterm delivery rates associated with initiation of HAART during pregnancy. 10th International Congress on Drug Therapy in HIV Infection, November 7-11. Glasgow. Poster 158. Published in Journal of the International AIDS Society 2010 13(Suppl 4):P158. http:\/\/www.jiasociety.org\/content\/13\/S4\/P158<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base HAART use in pregnancy has been associated with preterm delivery (PTD) in some studies but not others. Graham Taylor and colleagues performed an analysis of pregnancies prospectively recorded at a London clinic between 1995 and 2010. …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,35],"tags":[80],"class_list":["post-14271","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-pmtct-and-maternal-health","tag-hiv-10-glasgow-2010"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/14271","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=14271"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/14271\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=14271"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=14271"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=14271"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}