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Multiantiviral therapy for HIV in pregnancy is not associated with increased adverse perinatal outcome



Multiantiviral therapy for HIV in pregnancy is not associated with increased adverse perinatal outcome



American Journal of Obstetrics & Gynecology 184(1): S85



OBJECTIVE: Triple antiviral therapy for the treatment of HIV during pregnancy has been associated with preterm delivery and small-for-gestational-age (SGA) fetuses. We studied women during a 10-year period to determine whether treatment with multiple antiviral medications worsened the perinatal outcome. STUDY DESIGN: Retrospective review of women with HIV who were followed up at the Yale High Risk Clinic during their pregnancies and delivered at the Yale New Haven Hospital from 1990-2000. Maternal demographics, treatment regimens, HIV acquisition risk factors, and delivery information were reviewed. Women were grouped into 3 categories: no treatment (group 1), monotherapy (group 2), and multitherapy (group 3). RESULTS: A total of 93 patients were studied (group 1 = 21, group 2 = 34, and group 3 = 38). The groups were matched for age, race, gravidity/parity, risk factors for HIV, and mode of delivery. A total of 9%, 34%, and 15% of women in groups 1, 2, and 3, respectively, had AIDS. The initiation of antiviral therapy was equally distributed between each trimester (34% first trimester, 34% second trimester, and 32% third trimester). The mean gestational age at delivery was 37.0 weeks for group 1, 37.6 weeks for group 2, and 37.0 weeks for group 3. The mean birth weight was 2707 g for group 1, 2822 g for group 2, and 2680 g for group 3 (not significant, ANOVA, P = .05). There was no significant difference in the presence of intrauterine growth restriction or 5-minute Apgar score <7 between the groups. CONCLUSION: Our study found that aggressive antiviral therapy for HIV throughout the antepartum period does not increase preterm delivery, SGA, intrauterine growth restriction, or the need for neonatal resuscitation at delivery. Earlier concerns of preterm delivery and SGA associated with multiple antiviral therapies should not preclude one from using these agents during pregnancy. Further study of the reduction in vertical transmission with aggressive antepartum treatment is ongoing.

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Accession: 035349683

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