Prenatal protease inhibitor use and risk of preterm birth among HIV-infected women initiating antiretroviral drugs during pregnancy.

Abstract

BACKGROUND: Conflicting results have been reported among studies of protease inhibitor (PI) use during pregnancy and preterm birth. Uncontrolled confounding by indication may explain some of the differences among studies. METHODS: In total, 777 human immunodeficiency virus (HIV)-infected pregnant women in a prospective cohort who were not receiving antiretroviral (ARV) treatment at conception were studied. Births <37 weeks gestation were reviewed, and deliveries due to spontaneous labor and/or rupture of membranes were identified. Risk of preterm birth and low birth weight (<2500 g) were evaluated by using multivariable logistic regression. RESULTS: Of the study population, 558 (72%) received combination ARV with PI during pregnancy, and a total of 130 preterm births were observed. In adjusted analyses, combination ARV with PI was not significantly associated with spontaneous preterm birth, compared to ARV without PI (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.70-2.12). Sensitivity analyses that included women who received ARV prior to pregnancy also did not identify a significant association (OR, 1.34; 95% CI, 0.84-2.16). Low birth weight results were similar. CONCLUSIONS: No evidence of an association between use of combination ARV with PI during pregnancy and preterm birth was found. Our study supports current guidelines that promote consideration of combination ARV for all HIV-infected pregnant women.

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Published Version (Please cite this version)

10.1086/651232

Publication Info

Patel, Kunjal, David E Shapiro, Susan B Brogly, Elizabeth G Livingston, Alice M Stek, Arlene D Bardeguez, Ruth E Tuomala, undefined P1025 team of the International Maternal Pediatric Adolescent AIDS Clinical Trials Group, et al. (2010). Prenatal protease inhibitor use and risk of preterm birth among HIV-infected women initiating antiretroviral drugs during pregnancy. J Infect Dis, 201(7). pp. 1035–1044. 10.1086/651232 Retrieved from https://hdl.handle.net/10161/4142.

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Scholars@Duke

Livingston

Elizabeth Gresham Livingston

Professor of Obstetrics and Gynecology

My academic and clinical expertise is in the area of HIV infection in pregnancy. I have participated in the ACTG (Aids Clinical Trial Group as well as PACTG/IMPAACT and the AACTG) since 1988. My specific interest is in complications of medical and surgical treatments for HIV-infected pregnant women. I have served as a principal investigator on ACTG 249 (DDI pharmacokinetics in pregnancy) and AACTG 5084 (Metabolic complications of protease inhibitors in pregnancy).  I have a long time affiliation with the Duke Adult and Pediatric infectious disease clinics both for research and for clinical management of mothers and babies. Additionally I have clinical expertise in the care of diabetes in pregnancy, prenatal diagnosis and general high risk pregnancy care. I am an active member of the Division of Maternal Fetal Medicine and fully participate in our research efforts through recruitment of patients to trials within our division. I am involved in the education of medical students and residents.


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