Adverse Pregnancy Outcomes Among Women Who Conceive on Antiretroviral Therapy
| Autor: | Hoffman, Risa M, Brummel, Sean S, Britto, Paula, Pilotto, Jose H, Masheto, Gaerolwe, Aurpibul, Linda, Joao, Esau, Purswani, Murli U, Buschur, Shelley, Pierre, Marie Flore, Coletti, Anne, Chakhtoura, Nahida, Klingman, Karin L, Currier, Judith S, PROMISE (Promoting Maternal and Infant Safety Everywhere) 1077HS Team |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Spontaneous Contraception/Reproduction pregnancy outcomes antiretroviral therapy Abortion HIV Infections PROMISE (Promoting Maternal and Infant Safety Everywhere) 1077HS Team Reproductive health and childbirth Stillbirth Biological Sciences Medical and Health Sciences Microbiology Young Adult Infectious Diseases Anti-Retroviral Agents Pregnancy Humans HIV/AIDS Female conception |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 68, iss 2 |
| Popis: | BackgroundAdverse pregnancy outcomes for women who conceive on antiretroviral therapy (ART) may be increased, but data are conflicting.MethodsHuman 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.ResultsSubsequent 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]).ConclusionsWomen 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 |
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