Abstract
To describe the impact of initiating raltegravir (RAL)-containing combination antiretroviral therapy (cART) regimens on HIV viral load (VL) in pregnant women who have high or suboptimal VL suppression late in pregnancy. HIV-infected pregnant women who started RAL-containing cART after 28 weeks' gestation from 2007 to 2013 were identified in two university hospital centres. Eleven HIV-infected women started RAL at a median gestational age of 35.7 weeks (range 31.1 to 38.0 weeks). Indications for RAL initiation were late presentation in pregnancy (n=4) and suboptimal VL suppression secondary to poor adherence or viral resistance (n=7). Mean VL at the time of RAL initiation was 73,959 copies/mL (range <40 to 523,975 copies/mL). Patients received RAL for a median of 20 days (range one to 71 days). The mean decline in VL from the time of RAL initiation to delivery was 1.93 log, excluding one patient who received only one RAL dose and one patient with undetectable VL at the time of RAL initiation. After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission). There were no cases of perinatal HIV transmission. The present study provides preliminary data to support the use of RAL-containing cART to expedite HIV-1 VL reduction in women who have a high VL or suboptimal VL suppression late in pregnancy, and to decrease the risk of HIV perinatal transmission while avoiding Caesarean section. Further assessment of RAL safety during pregnancy is warranted.
Highlights
ART used during pregnancy Age, ART Coinfec
In our experience, adding RAL to a cART regimen was useful in rapidly reducing HIV-1 VL to prevent perinatal transmission in women who have high VL or suboptimal suppression late in pregnancy
Our findings are consistent with previously published cases of RAL use late in pregnancy, which are summarized in Table 2 (8,15-18,2022,24-26,28)
Summary
A retrospective review of two Canadian HIV perinatal databases (those of the Oak Tree Clinic at BC Woman’s Hospital, Vancouver, British Columbia, and of the Grossesse Avec Maladie Infectieuse clinic at SainteJustine Hospital, Montreal, Quebec) was conducted to identify HIVinfected pregnant women who initiated treatment with RAL (400 mg twice per day orally) after 28 weeks’ gestation. Data collected between 2007, the year when RAL became available, and December 2013 were reviewed. Each patient’s chart was retrospectively abstracted for data including RAL indication, tolerance and timing of exposure. The standard of care in both clinics included treatment of HIVinfected pregnant women with cART regardless of baseline CD4 cellcount and HIV-1 VL, as well as assessment of the women’s clinical, virological and immunological status every four weeks. HIV-negative status in infants was defined presumptively by at least two negative HIV RNA polymerase chain reaction test results before four months of age, and confirmed by the absence of HIV-1 antibody at 18 months of age
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