Abstract
We conducted a retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015) aimed at evaluating outcomes in HIV-infected pregnant women (HIPW), who were prescribed raltegravir (RAL)-containing antiretroviral therapy (ART). A total of 239 HIPW were enrolled in our study; among them 31 received RAL (12.9%) at different clinical stages: i) intensification (INS): addition of RAL to current ART because of detectable antepartum viral load, 13 (41.9%); ii) late presenter (LP): standard ART + RAL as fourth drug, 15 (48.4%); iii) treatment of resistant-HIV: 3 (9.7%). Median gestational age at RAL initiation was 34 weeks and median exposure was 30 days. In INS-group, median viral load (VL) decrease was 1.48 log10. In LP-group, median VL decline was 2.15 log10. No clinical adverse events or maternal intolerance attributable to RAL were observed. Elective cesarean section was done in 51.7%; mild elevation of transaminases was observed in 35% of neonates. No vertical transmission was documented.
Highlights
Since the sucincreasing anecdotal evidence of its efficacy to rapidly reduce maternal viral load when used as a part of antiretroviral therapy (ART) regimens late in pregnancy, with few maternal side effects and no detrimental effects on the fetus
RAL has been included as a preferred agent in pregnancy according to the U.S Department of Health and Human Services (DHHS) guidelines.[11]
In order to increase local information regarding the use of RAL in our population of HIV-infected pregnant women we underwent a retrospective study in a general hospital in Buenos Aires, Argentina during a seven year-period (2009-2015)
Summary
During the period of analysis, a total of age); those patients were prescribed standard ART according to national guidelines + RAL as fourth drug: 15 patients (48.4%); iii) treatment of drug-resistant-HIV prior to retroviral therapy (ART) of pregnant 239 HIV-infected pregnant women were conception: 3 patients (9.7%). The median (interquartile range) of age, settings. Baseline viral load and CD4 T-cell count have been evaluated to address the feasibil- Prescription of RAL in this population were: 23 years (19-32); 6840 copies/mL ity of preventing MTCT in resource-con- increased over time as follows: 8/130 (2445-66,650) and 300/μL (197-436), strained settings most heavily affected by (6.15%) in period 2009-2012 vs 23/109 in respectively. MTCT remains high (>4%) in (OR): 4, 95% Confidence Interval (CI): 1.7- group median viral load prior to RAL addi-.
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