Ambulatory Treatment Research Articles

Prevalence and factors associated with renal disease among patients with newly diagnoses of HIV in Brazzaville, Republic of Congo

The aim of this study was to determine the prevalence of kidney disease in patients newly diagnosed as HIV-positive in Brazzaville and to identify the associated risk factors. Descriptive and analytical study of patients diagnosed with HIV infection at the Ambulatory Treatment Center in Brazzaville, Republic of Congo, from January 1, 2009, through December 31, 2010. Estimated glomerular filtration rate (eGFR) was assessed with the Modification of Diet in Renal Disease equation (MDRD-GFR), and kidney disease was defined by an eGFR less than 60 mL/min/1.73 m(2). We conducted a univariate and then a multivariate logistic regression analysis to determine the factors associated with kidney disease in this population. The study included 562 patients newly identified as HIV-infected, 66.13% of whom were women. Their median age was 38.84 years interquartile range (IQR): 33.18-46.23) and their median body mass index (BMI) 20.31 kg/m(2) (IQR: 17.97-22.89). Their median CD4 count was 192 cells/mm(3) (IQR: 81-350), and 70.8% were at WHO stage III/IV. Finally, the median MDRD-GFR was 95.59 (IQR: 78.76-114.92) mL/min/1.73 m(2) and 8.5% had a GFR less than 60 mL/min/1.73 m(2), that is, moderate impairment of kidney function. The only factor associated with kidney disease in the multivariate analysis was a BMI less than 18.5 kg/m(2) (adjusted odds ratio: 2.54, 95% confidence interval: 1.25-5.15, p = 0.01). The prevalence of kidney disease in patients newly diagnosed with HIV in Brazzaville is relatively high. The only factor associated with it in the multivariate analysis was a BMI less than 18.5 kg/m(2).

Tumoral Calcinosis in a Patient on Peritoneal Dialysis

A 23-year-old woman presented with multiple swellings around her shoulders which had developed over many months. She had been on continuous ambulatory peritoneal dialysis treatment for 4 years for renal failure caused by polycystic kidney disease. Her compliance with the dialysis prescription had been very poor. Examination revealed multiple large hard masses related to both shoulders and ankles; the largest was 9.5 × 5 cm. Laboratory results revealed severe hyperparathyroidism and an elevated calcium × phosphate product. A biopsy showed dense fibrous tissue containing large areas of calcification. Radiographs showed extensive metastatic calcification around the right shoulder (Figure 1A). The patient was re-educated and supervised with her peritoneal dialysis. After 6 months there was marked reduction in the size of the mass (Figure 1B). She then had total parathyroidectomy with forearm reimplantation of one gland. A radiograph (Figure 1C) 1 month later showed almost complete resolution. Figure 1. A, Radiograph showing extensive metastatic calcification around the patient's right shoulder. B, Radiograph shows marked reduction in the size of the mass 6 months after peritoneal dialysis and re-education of patient. C, One month after total parathyroidectomy ... In this case, tumoral calcinosis was the result of metastatic calcification related to underdialysis with a chronically raised calcium phosphate product. The condition completely resolved with proper dialysis and parathyroidectomy.

Ambulatory treatment in the management of pneumothorax: a systematic review of the literature

IntroductionSpontaneous pneumothorax (SP) is broken down into primary (PSP: no known underlying lung disease), secondary (SSP: known lung disease) and from trauma or iatrogenic pneumothorax (IP). Current treatments include a...

Study of the psychological preparation on the dental care of children with special needs

The psychology in Dentistry is a great challenge for the clinicians during the care of their patients. The conditioning of a patient to achieve a behavior meeting the professional’s needs for developing a procedure within the quality standards is necessary. When this conditioning focuses on the child patients the challenge is even greater because the child will use all ways to make difficult the action of the clinician due to fear or discomfort. The ability of the dentist to condition the patient will be directly proportional to the training and theoretical knowledge acquired. Considering the Patients with Special Needs (PSN), this training should be differentiated because there is the physical, cognitive, and the previous dental/medical history in addition to the psychological and emotional difficulties. The aim of this study was to evaluate the profile of the patient to be conditioned satisfactorily and which conditioning techniques would be more efficient to ambulatory dental care of PSN. Thirty patients, both genders, aged from 20 months to 11 years-old who were enrolled at the ambulatory treatment of NEAPE were observed. It was concluded that when there is the cognitive development of the individual, they are able to be conditioned for the ambulatory care; the use of auxiliary methods is important in the conditioning for the ambulatory care of the individuals; the syndromic patients had the best results for the conditioning aiming to the ambulatory care; there was a significant improvement in the behavior of individuals between the first and last appointments.

DGI-018 Budget Impact Analysis on New 3-Year Imatinib Adjuvant Treatment For Patients with Operable GIST at High Risk of Recurrence

Background The results of Phase III of the (SSG)XVIII/AIO clinical study on imatinib (IM) in adjuvant treatment of GIST show that, after five years of follow up, 3 years of...

Proper use of Quinolones for canine colitis ambulatory treatment: literature review and REQUEST guidelines

The literature analysed by REQUEST (REassesing QUinolone European STandard) using inclusion and exclusion criteria allows to make the conclusion that the proper use of fluoroquinolones (FQ) in canine colitis requires rigorously performed qualification to specific antimicrobial treatment. An infectious agent responsive to FQ therapy plays an integral role in the clinical manifestation of canine colitis, especially histiocytic ulcerative colitis (HUC) in young Boxer dogs. This supports the use of FQ in these cases. The Request guidelines for proper use of FQ in canine colitis is established, according to the available literature data.

Thromboprophylaxis in Ambulatory Lung Cancer Treatment

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, are common problems experienced by patients with lung cancer that can impact treatment plans, prognoses, and survival. Patients with lung cancer are at greatest risk for development of VTE in the ambulatory care treatment setting. Literature does exist on VTE management for medical and surgical oncology inpatients, as well as clinical guidelines for inpatient prophylaxis; however, published evidence is lacking on outpatient risk and thromboprophylaxis in medical oncology outpatients, particularly patients with lung cancer. Because patients with lung cancer treated in the ambulatory setting have established risks for VTE, they may benefit from thromboprophylaxis. Clinical guidelines for outpatient thromboprophylaxis direct the clinical practice for thromboprophylaxis in lung cancer treatment. The purpose of the current article is to explore the VTE risks associated with ambulatory lung cancer treatment and to review the recommended guidelines for thromboprophylaxis to guide clinical decision making for patients with lung cancer.

Irinotecán y temozolomida en tumores sólidos pediátricos en recaída o refractarios

IntroductionThe prognosis of refractory or relapsed pediatric solid tumors is very poor, and there is no standard treatment for this condition. The combination of irinotecan and temozolomide has proved useful in adults as a second-line treatment of different solid tumors. In pediatric patients, this combination has been effective in Ewing's sarcoma, neuroblastoma, and relapsed or refractory rhabdomyosarcoma. Patients and methodsA retrospective study was conducted on 32 pediatric patients with refractory or relapsed solid tumors, who were treated with irinotecan and temozolomide in the Oncology Department at Children's Hospital Niño Jesus from September 2005 to June 2012. The clinical characteristics, treatment performed, toxicity and outcome, were analyzed. ResultsThirty-two patients received a total of 180 cycles. Of the 30 evaluable patients, 10 (33%) had a positive response (2 complete remission and 8 partial remission), and in 8 (27%) the disease remained stable. Almost all (94%) of the patients achieved a response in the first four cycles. Of the 180 cycles analyzed, only 50 (28%) had toxicity, and of these only 15 (8%) were grade iii-iv. The most common toxicity was diarrhea appearing in 18 patients. All patients received ambulatory treatment, except three of them who required hospitalization due to symptoms of their underlying disease. ConclusionThe combination of irinotecan and temozolomide is well tolerated and active against pediatric refractory or relapsed solid tumors.

Pharmacokinetics and pharmacodynamics of moist inhalation epinephrine using a mobile inhaler

BackgroundIntramuscular (L-)epinephrine is used as self-medication for serious hypersensitivity reactions. Inhalative administration has the theoretical advantage of a more rapid absorption and better controllability.ObjectivesThe current trial was conducted to explore pharmacokinetics and pharmacodynamics of two nebulized inhalative epinephrine doses (4 mg and 8 mg in aqueous solution) using a mobile pocket inhaler relative to intramuscular administration (0.3 mg) and placebo.MethodsThis randomized, open-label, change-over pilot study involved eight young healthy men and women. Noncompartmental pharmacokinetic and pharmacodynamic parameters were calculated from epinephrine plasma concentrations and hemodynamic parameters.ResultsMean exposure to epinephrine decreased from the 8 mg dose to the 4 mg inhalative dose, and further with the 0.3 mg intramuscular dose, with active treatments showing significantly higher concentrations than placebo (geometric mean area under the curve AUC0-t(last) values: 282, 236, 204 and 81.6 hr*ng/L). Maximal concentrations were reached within approximately 15 min for all active treatments. Epinephrine effects for inhalative administrations on heart rates were significantly higher than those for the intramuscular or placebo administration, while no excessive effects occurred. Pronounced overall variability prohibited a definite assessment of relative bioavailability between treatments. However, results indicated that epinephrine concentrations obtained following the 8 mg inhalative dose were not inferior to those after 0.3 mg i.m.ConclusionsA relevant fraction of moist inhalation epinephrine doses is absorbed and mediates systemic effects. This suggests that administration of epinephrine via a suitable pocket inhaler device may be beneficial in ambulatory emergency treatment of systemic hypersensitivity reactions.EudraCT number: 2010-021493-11Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-012-1465-5) contains supplementary material, which is available to authorized users.

Effects of ambulatory self-control on renal function and electrolyte metabolism in patients with severe heart failure

Aim. To investigate the effects of the ambulatory self-control treatment strategy on renal function, electrolyte metabolism, functional status, and the number of repeat hospitalisations in patients with chronic heart failure (CHF). Material and methods. In total, 122 patients with severe CHF (NYHA class III-IV) were divided into 3 groups: Group I – ambulatory self-control after in-hospital education in the “CHFPatientSchool”; Group II – standard in-hospital education in the “CHFPatientSchool”; and Group III – controls. Group I participants could selfadminister torasemide (in pre-determined doses; under control of blood potassium, sodium, and creatinine) in case of oedema and dyspnoea development. If torasemide treatment was ineffective, Group I patients would have a telephone consultation with a doctor. During the in-hospital treatment, as well as after 3, 6, and 9 months of ambulatory treatment, the following parameters were assessed: the number of repeat hospitalisations, functional status (6-minute walking test), calculated glomerular filtration rate (GFR; CKD-EPI), morning microalbuminuria, serum levels of potassium and sodium, therapy compliance, and knowledge on CHF-related issues. Results. The number of repeat hospitalisations in Group I, compared to Groups II and III, decreased by 37% and 45%, respectively. In the 6-minute walking test at 9 months, the distance in Group I increased from 174,5 m to 248,5 m, while in Groups II and III, it did not change significantly. Group I did not demonstrate any negative GFR dynamics, while this parameter progressively and similarly decreased in the other two groups. At 9 months, albuminuria levels in Group I (44,5±25,3 mg/l) were significantly lower than in Group II (58,7±32,5 mg/l) and Group III (62,8±36,9 mg/l). Among Group I patients, hyperkalaemia was not observed, and hyponatraemia was significantly less common than in Groups II and III. The CHF knowledge and therapy compliance were better in Group II, compared to Group III, only during the first 3 months of the follow-up; Group I demonstrated consistently high levels of these parameters throughout the study period. Conclusion. The strategy of ambulatory self-control, compared to the standard ambulatory observation, significantly reduced the need for repeat hospitalisations, improved functional status, electrolyte metabolism, and therapy compliance parameters, and postponed the progression of renal dysfunction in CHF patients.

Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review.

Pregnancies complicated by diabetes are associated with increased neonatal and maternal complications. The most serious maternal complication is the risk of developing type 2 diabetes, 10-12 years after the delivery. For rigorous control over blood glucose, pregnant women are treated through ambulatory management or hospitalization. The aim of this study was to evaluate the effectiveness of ambulatory management versus hospitalization in pregnancies complicated by diabetes or hyperglycemia. Systematic review conducted in a public university hospital. A systematic review of the literature was performed and the main electronic databases were searched. The date of the most recent search was September 4, 2011. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data. Only three studies were selected, with small sample sizes. There was no statistically significance different between ambulatory management and hospitalization, regarding mortality in any of the subcategories analyzed: perinatal and neonatal deaths (relative risk [RR] 0.65; 95% confidential interval [CI]: 0.11 to 3.84; P = 0.63); neonatal deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43); and infant deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43). This review, based on studies with high or moderate risk of bias, showed that there was no statistically significant difference between ambulatory management and hospital care, regarding reduction of mortality rates in pregnancies complicated by diabetes or hyperglycemia. It also suggested that there is a need for further randomized controlled trials on this issue.

Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block

Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.

Sympathetic activity and arterial hypertension: potential for correction

The paper is focussed on the role of increased sympathetic activation in the pathogenesis of arterial hypertension (AH), its exacerbations (hypertensive crises), and complications. One of the effective methods of interrupting pathogenetic “vicious circles” in AH is the blockage of peripheral alpha-adrenoreceptors. One of the medications of choice for urgent treatment of hypertensive crises, as well as for long-term ambulatory treatment, is urapidil – a peripheral sympatholytic with characteristics of a central serotonin receptor agonist.

Failure of Ambulatory Treatment in Cap Patients Leading to Subsequent Hospitalization and its Association to Risk Factors

Background: Outpatient treatment is an increasingly used option in Community-Acquired Pneumonia (CAP). Risk factors for deterioration and subsequent hospitalization are poorly characterized. Material and Methods: A prospective study was conducted to assess risk factors associated with hospitalization of CAP-patients initially treated in an outpatient setting. Clinical history, severity of disease, physical examination findings, laboratory test results, initial treatment and outcome were prospectively documented in both groups. Data derived from a multicenter prospective study initiated by the German competence network for communityacquired pneumonia CAPNETZ. The network includes 10 clinical centers representing hospital and outpatient facilities from all levels of health care. 5431 patients with CAP were screened for inclusion. 1517 of these patients were initially treated as outpatients and included. 1403 patients were treated exclusively in an outpatient setting, 114 (8.1%) were hospitalized after initial outpatient treatment. Results: Compared to patients treated exclusively in an outpatient setting patients with subsequent hospitalization had a significantly higher 28-day mortality rate (4.2% vs. 0.2%, p= 65 years as the only risk factor. Cerebrovascular disease, chronic kidney disease and diabetes mellitus were overrepresented in this patient group. In addition, cephalosporin monotherapy was identified as independent risk factor for hospitalization. Conclusion: In ambulatory CAP patients subsequent hospitalization was observed mainly in low CRB-65 risk classes and was associated with comorbidities and the choice of initial therapy

Therapeutic outcome of multifocal Langerhans cell histiocytosis in adults treated with the Special C regimen formulated by the Japan LCH Study Group

Little information is available regarding effective systemic therapies for adult Langerhans cell histiocytosis (LCH). The Japan LCH Study Group has formulated an ambulatory treatment regimen for adult patients with LCH. In total, 14 patients (median age 43years, range 20-70years) with multifocal LCH with biopsy-confirmed histology were enrolled. None had received cytoreductive agents for LCH previously. Four had single system (SS) and ten had multi system (MS) disease. All were treated with the Special C regimen, which consists of vinblastine/prednisolone and methotrexate with daily 6-mercaptopurine for 36weeks. At the end of the therapeutic regimen, all SS patients achieved no active disease (NAD), and six of the ten MS patients showed a response (NAD in two, partial response in four). At the last follow-up (median 34months), 11 patients were alive (NAD in eight and active disease in three). Of the three deceased, one died of hemorrhage during the Special C treatment, and two of infections during subsequent therapy. Although this study is limited by the small sample size, this ambulatory regimen shows signs of efficacy for adult LCH. This was particularly evident for patients with multifocal SS disease, but half of those with MS disease also benefited.

Reading increases ocular illuminance during light treatment

Bright-light treatment is a safe and effective treatment for the management of winter seasonal affective disorder (SAD). In a recent study, we found that the relative duration of reading was positively associated with likelihood of remission after six weeks of light treatment. Two technicians measured the illuminance of a light box with a light meter directed towards the center of reading material that was placed on a table in front of the light box. The measurement was also performed after reading material was removed. The two measurements were performed in a randomized order. Friedman analysis of variance with Wilcoxon post-hoc tests were used to compare illuminance with vs. without reading. The presence of the reading material increased illuminance by 470.93 lux (95% CI 300.10-641.75), p<0.0001. This is a technical report done under conditions intended to mimic those of typical ambulatory light treatment as much as possible. As reading materials reflect light from the light box, reading during light therapy increases ocular illuminance. If confirmed by future studies using continuous recordings in randomized design, instructing SAD patients to read during light therapy may contribute to a more complete response to light treatment. The downside of specific relevance for students, is that reading, in particular, with bright light in the late evening/early night may induce or worsen circadian phase delay, adversely affecting health and functioning.

Improving infusion therapy efficiency at the Woodlands Regional Care Center (RCC).

84 Background: The Woodlands RCC opened the Ambulatory Treatment Center in September 2010. The center houses 14 infusion units. Within 1 year, the demand for its infusion therapy services had more than doubled with continued rapid growth expected. The perception was that more patients could not be accommodated without additional space and staff. Therefore, a performance improvement team was formed in August 2011 with the goal to increase operational efficiency to satisfy patient demand, while maintaining the highest level of quality care. The increased access for patients allows for treatment to start sooner. Methods: The six sigma Define-Measure-Analyze-Improve-Control methodology was used to manage the project, and several lean and six sigma tools were utilized. The project commenced with a project charter with a measureable AIM statement to increase infusion volumes from 1.7 to 2.4 patients/unit per 9 hour day. Historical data was extracted, and all patients’ movements were timed for 3 weeks. Benchmarking, observations, and process mapping were also performed. Baseline performance was measured using SPC charts. Sources of variation were uncovered using statistical quality tools, brainstorming techniques, and cause/effect analysis. Key interventions consisted of standardized scheduling practices, development of a scheduling template, creation of a fast track room, new processes for overbooks and preschedules, and work balancing of nursing staff using an acuity rating system. In addition, staff workload was redistributed, and the lab was reorganized. Results: Within 3 months, the center met targeted capacity and provided regional care access to 41% more patients without additional staff, space, or working hours. By March 2012, the center accommodated 67% more patients (2.9/unit or 40/day) without adversely affecting patient wait time. Infusion room utilization increased by 15%. Conclusions: Although space constrained, The Woodlands RCC was presented with the challenge to provide patients’ open access to infusion therapy services. The team successfully applied lean and six sigma principles to evaluate the current state, perform a gap analysis, and deploy interventions to support quality and operate more efficiently.

P121 Ambulatory Treatment For Pneumothorax: A Systematic Review of the Literature and Case For Outpatient Orientated Care?

IntroductionSpontaneous pneumothorax (SP) is broken down into primary (PSP: no known underlying lung disease), secondary (SSP: known lung disease) and non-spontaneous from trauma or iatrogenic pneumothorax (IP). PSP carries a...

5-Azacitidine Plus Vorinostat As Maintenance Therapy of Second Remission in AML Instead of High Doses of Consolidation with Cytarabine

AbstractAbstract 4348Patients with refractory AML after failure of reinduction of remission treatment (usually the clasical 7+3) have few options of effective reinduction regimen. Once a second remission is obtained, the standard strategies implies an allogenic BMT or consolidation treatment with high doses of cytarabine but the BMT requires a match or alternative donor and the chemotherapy implies myelotoxicities and some patients have high risk of severe complications versus recurrent relapse and death.A 36 years old male with AML M4 intermediate risk since april 2010 was treated conventionally with 7+3 regimen (Cytarabine + Idarubicin), after that he received 4 cycles of high doses of Cytarabine as consolidation. On October 2010 he received an autologous BMT (ABMT) because he does not have an HLA compatible donor. After 12 months of complete remission post ABMT he relapsed on October 2011. He received as reinduction regimen 7+3 (Cytarabine + Doxorubicin) and he failed to obtain remission. He received a salvage treatment with high dose of Cytarabine 3 gr/m2 (6 doses) followed by high doses of Etoposide 60 mg/kg in continuous infusion. He achieved complete remission and then developed Aspergillus pneumonia during the myelosupressed period and a thoracoscopy was performed for treatment, he was discharged at the end of November 2011.In the face of the impossibility of conventional consolidation therapy, and in the presence of poor general conditions, we started a treatment model based on epigenetic alternative therapy with the objective to maintain remission. In December 2011 he was started an ambulatory treatment based on subcutaneous administration with 5-azacitidine 75mg/m2/day during 7 days every 28 days for two cycles; during treatment he developed myelosuppression without the need of stimulating factors or transfusions. Posteriorly he continued with two new cycles of 5-azacitidine 50mg/m2/day during 10 days plus Vorinostat 200 mg every 24 hours during 14 days. Each month since the beginning of the epigenetic therapy, BMA was performed with flow cytometry and immunophenotype performed that showed a persistent remission until May 2012 when he relapsed.Therefore epigenetic therapy maintained in remission a high risk patient, improved his general conditions, and posteriorly allowed him to be able to receive an haploidentical bone marrow transplant. Disclosures:No relevant conflicts of interest to declare.

Use of efavirenz during the first trimester and resulting pregnancy outcome: experience of the Ambulatory Treatment Center of Brazzaville

BackgroundThe aim of this study is to report the experience of the Ambulatory Treatment Center of Brazzaville regarding the use of efavirenz (EFV) during pregnancy.MethodsA retrospective cohort study of HIV‐positive women was conducted at the Ambulatory Treatment Center of Brazzaville. The study examined the use of an anti‐retroviral treatment containing EFV in women who reported being pregnant during follow‐up between January 2009 and September 2011. Demographic, clinical and biological data, and adverse effects associated with exposure to EFV during pregnancy were assessed after each pregnancy from the register of pregnant women in terms of preterm delivery (birth occurring before 37 weeks of age) and spontaneous miscarriage (spontaneous expulsion of the fetus before 15 weeks of age).ResultsOf 220 patients on an anti‐retroviral treatment who reported being pregnant during follow‐up, 34 patients were administered combinations containing two nucleoside reverse transcriptase inhibitors (AZT/3TC=27; d4T/3T=4; TDF/FTC=3) and EFV, with a median age of 31.95 years (IQR: 27.71–36.37) and median durations of exposure to EFV of 11.81 months (IQR: 5.46–21.22) and 35.14 weeks (IQR: 11–39.86) before and during pregnancy, respectively. In 13 patients who reported to be in their first trimester of pregnancy, a change from EFV to nevirapine was made in nine of these patients. The median CD4 count was 271.5 cells/mm3 (IQR: 233.5−414.5) and 305 cells/mm3 (IQR: 205–408) in early pregnancy and at delivery, respectively; the viral load was undetectable in 90% and 85.7% of the patients, respectively. Twenty‐three deliveries took place after 37 weeks gestation; additionally, five preterm deliveries, four spontaneous miscarriages, one terminated pregnancy, and one death in utero occurred.ConclusionsEFV used during the first trimester of pregnancy offers security, but the number of fetal deaths is also important.