Abstract
BackgroundThe National Study of HIV in Pregnancy and Childhood (NSHPC) conducts comprehensive population-based surveillance of pregnancies in women with HIV infection in the United Kingdom/Ireland. Use of antepartum antiretroviral therapy (ART) for prevention of mother-to-child transmission (MTCT) and to treat maternal infection, if required, is standard practise in this population; lopinavir/ritonavir (LPV/r) is commonly used. The study objective was to examine the use of LPV/r among pregnant women with HIV infection to describe maternal and foetal outcomes.MethodsThe NSHPC study collected maternal, perinatal and paediatric data through confidential and voluntary obstetric and paediatric reporting schemes. Pregnancies reported to the NSHPC by June 2013, due to deliver 2003–2012 and with LPV/r exposure were included in this analysis, using pregnancy as the unit of observation.ResultsFour thousand eight hundred sixty-four LPV/r-exposed pregnancies resulting in 4702 deliveries in 4118 women were identified. Maternal region of birth was primarily sub-Saharan Africa (77 %) or United Kingdom/Ireland (14 %). Median maternal age at conception was 30 years. LPV/r was initiated preconception in 980 (20 %) and postconception in 3884 (80 %) pregnancies; median duration of antepartum LPV/r exposure was 270 and 107 days, respectively. Viral load close to delivery was <50 copies/mL in 73 % and <1000 copies/mL in 94 % of women. 63 % of deliveries were by caesarean section (elective, 62 %; emergency, 38 %). Among singleton live births, 13 % were <37 weeks of gestation (2.5 % <32 weeks) and 15 % had birth weight <2500 g (2.3 % <1500 g). MTCT rates were 1.1 (2003–2007) and 0.5 % (2008–2012). 134 live born children (2.9 %) had ≥1 congenital abnormality.ConclusionsThe results of this analysis using real-world data from a large number of pregnant women with HIV infection in the United Kingdom and Ireland who received LPV/r-containing ART regimens demonstrate that these regimens have a good safety profile and are effective for viral suppression during pregnancy, with associated low rates of MTCT.
Highlights
The National Study of human immunodeficiency virus (HIV) in Pregnancy and Childhood (NSHPC) conducts comprehensive population-based surveillance of pregnancies in women with HIV infection in the United Kingdom/Ireland
Using data from the NSHPC for pregnancies that were due to deliver between 2003 and 2012, the current study examined the use of LPV/r among pregnant women with HIV infection in the United Kingdom and Ireland to explore its association with maternal and foetal outcomes, including viral suppression, gestational age at delivery, prevalence of low birth weight at delivery, mother-to-child transmission (MTCT) rates and reported adverse infant outcomes
The pregnancies were stratified by timing of LPV/r exposure, with 980 pregnancies conceived whilst the woman was receiving LPV/r therapy and 3884 pregnancies whilst LPV/r was initiated in the antenatal period
Summary
The National Study of HIV in Pregnancy and Childhood (NSHPC) conducts comprehensive population-based surveillance of pregnancies in women with HIV infection in the United Kingdom/Ireland. Observational data collected through the NSHPC can be used to examine trends in the diagnosis and management of HIV in pregnant women and related pregnancy outcomes Data from this and other studies have demonstrated that vertical transmission risk reduction strategies, such as the use of antiretroviral therapy (ART) during pregnancy, delivery management and avoidance of breastfeeding, can result in an appreciable reduction of the mother-to-child transmission (MTCT) rate from approximately 20 to 0.5 % among populations living in resource-rich settings [1,2,3,4,5,6,7,8]. As with any drug taken during pregnancy, antenatal exposure to ART agents raises concerns regarding toxicity, teratogenicity and an increased risk of adverse pregnancy outcomes, including preterm delivery, low birth weight and congenital abnormalities [16,17,18,19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
