Outcomes Following Pregnancy Conception on Antiretroviral Therapy: A Call for More Data
| Autor: | Shahin Lockman, Victor De Gruttola |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty business.industry 030106 microbiology Pregnancy Outcome HIV Infections Antiretroviral therapy 03 medical and health sciences 0302 clinical medicine Infectious Diseases Pregnancy conception Pregnancy Antiretroviral Therapy Highly Active Medicine Humans Female 030212 general & internal medicine business Intensive care medicine Articles and Commentaries |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 68(2) |
| ISSN: | 1537-6591 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|