Adverse Pregnancy Outcomes Among Women Who Conceive on Antiretroviral Therapy.

Published

Journal Article

Background:Adverse pregnancy outcomes for women who conceive on antiretroviral therapy (ART) may be increased, but data are conflicting. Methods:Human immunodeficiency virus-infected, nonbreastfeeding women with pre-ART CD4 counts ≥400 cells/μL who started ART during pregnancy were randomized after delivery to continue ART (CTART) or discontinue ART (DCART). Women randomized to DCART were recommended to restart if a subsequent pregnancy occurred or for clinical indications. Using both intent-to-treat and as-treated approaches, we performed Fisher exact tests to compare subsequent pregnancy outcomes by randomized arm. Results:Subsequent pregnancies occurred in 277 of 1652 (17%) women (CTART: 144/827; DCART: 133/825). A pregnancy outcome was recorded for 266 (96%) women with a median age of 27 years (interquartile range [IQR], 24-31 years) and median CD4+ T-cell count 638 cells/μL (IQR, 492-833 cells/μL). When spontaneous abortions and stillbirths were combined, there was a significant difference in events, with 33 of 140 (23.6%) in the CTART arm and 15 of 126 (11.9%) in the DCART arm (relative risk [RR], 2.0 [95% confidence interval {CI}, 1.1-3.5]; P = .02). In the as-treated analysis, the RR was reduced and no longer statistically significant (RR, 1.4 [95% CI, .8-2.4]). Conclusions:Women randomized to continue ART who subsequently conceived were more likely to have spontaneous abortion or stillbirth, compared with women randomized to stop ART; however, the findings did not remain significant in the as-treated analysis. More data are needed on pregnancy outcomes among women conceiving on ART, particularly with newer regimens.

Full Text

Duke Authors

Cited Authors

  • Hoffman, RM; Brummel, SS; Britto, P; Pilotto, JH; Masheto, G; Aurpibul, L; Joao, E; Purswani, MU; Buschur, S; Pierre, MF; Coletti, A; Chakhtoura, N; Klingman, KL; Currier, JS; PROMISE (Promoting Maternal and Infant Safety Everywhere) 1077HS Team,

Published Date

  • January 2019

Published In

Volume / Issue

  • 68 / 2

Start / End Page

  • 273 - 279

PubMed ID

  • 29868833

Pubmed Central ID

  • 29868833

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

International Standard Serial Number (ISSN)

  • 1058-4838

Digital Object Identifier (DOI)

  • 10.1093/cid/ciy471

Language

  • eng