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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception
AIDS, Volume 25, No. 13, Year 2011
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Description
Objectives: To describe antiretroviral therapy (ART) use and clinical status, at start of and during pregnancy, for HIV-positive women receiving ART at conception, including the proportion conceiving on drugs (efavirenz and didanosine) not recommended for use in early pregnancy. Methods: Women with a pregnancy resulting in a live-birth after 1995 (n = 1537) were identified in an observational cohort of patients receiving HIV care at 12 clinics in the UK by matching records with national pregnancy data. Treatment and clinical data were analysed for 375 women conceiving on ART, including logistic regression to identify factors associated with changing regimen during pregnancy. Results: Of the 375 women on ART, 39 (10%) conceived on dual therapy, 306 (82%) on triple therapy and 30 (8%) on more than three drugs. In total, 116 (31%) women conceived on a regimen containing efavirenz or didanosine (69 efavirenz, 54 didanosine, seven both). Overall, 38% (143) changed regimen during pregnancy, of whom 44% (n = 51) had a detectable viral load around that time. Detectable viral load was associated with increased risk of regimen change [adjusted odds ratio 2.97, 95% confidence interval (CI) (1.70-5.19)], while women on efavirenz at conception were three times more likely to switch than women on other drugs [3.40, (1.84-6.25)]. Regimen switching was also associated with year at conception [0.89, (0.83-0.96)]. Conclusion: These findings reinforce the need for careful consideration of ART use among women planning or likely to have a pregnancy in order to reduce viral load before pregnancy and avoid drugs not recommended for early antenatal use. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Huntington, Susie E.
United Kingdom, London
Ucl Medical School
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Bansi-Matharu, Loveleen K.
United Kingdom, London
Ucl Medical School
Thorne, Claire N.
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Anderson, Jane
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Newell, Marie Louise
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
South Africa, Durban
University of Kwazulu-natal
Taylor, Graham P.
United States, Rochester
Saint Mary's Hospital
Morris, Lynn G.
United Kingdom, London
Ucl Medical School
United Kingdom, London
Public Health England
Hill, Teresa
United Kingdom, London
Ucl Medical School
Tookey, Pat A.
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Sabin, Caroline Anne
United Kingdom, London
Ucl Medical School
Statistics
Citations: 18
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0b013e32834982af
e-ISSN:
14735571
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Case-Control Study
Participants Gender
Female