Does changing antiretroviral therapy in the first trimester for pregnancy-related concerns have an impact on viral suppression ? - Université Sorbonne Paris Cité Accéder directement au contenu
Article Dans Une Revue Journal of Acquired Immune Deficiency Syndromes - JAIDS Année : 2019

Does changing antiretroviral therapy in the first trimester for pregnancy-related concerns have an impact on viral suppression ?

Eida Bui
  • Fonction : Auteur
  • PersonId : 951086
Caroline Simon Toulza
  • Fonction : Auteur

Résumé

OBJECTIVE: To determine whether changing antiretroviral therapy (ART) during pregnancy because of concern about fetal risks led to poorer virological outcomes. METHODS: All pregnancies in women with HIV-1 infection enrolled in the national multicenter prospective French Perinatal cohort at 14 week gestation or more were included between January 2005 and December 2015, if the mother was on ART at conception with a plasma viral load <50 copies/mL. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy and defined as for safety concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics. RESULTS: Of 7079 pregnancies in the overall cohort, 1797 had ART at conception with a viral load <50 copies/mL before 14 week gestation. Of these, 22 changed regimens in the first trimester for intolerance, and 411 of the remaining 1775 (23%) solely for safety concerns. The proportion of change was higher when the initial treatment was not recommended in the national guidelines (OR adjusted: 23.1 [14.0-38.2]), than when it was an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for safety concerns did not lead to poorer virological control, compared with pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]). CONCLUSIONS: Changing ART early in pregnancy to regimens considered safer for pregnancy, and neonatal health did not have a destabilizing effect on viral suppression.
Fichier principal
Vignette du fichier
Manuscript switch AIDS 20180430.pdf (687.14 Ko) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)
Loading...

Dates et versions

inserm-02070251 , version 1 (17-03-2019)

Identifiants

Citer

Violaine Peyronnet, Josiane Warszawski, Jeanne Sibiude, Olivia Dialla, Agnès Bourgeois Moine, et al.. Does changing antiretroviral therapy in the first trimester for pregnancy-related concerns have an impact on viral suppression ?: Changing ART in pregnancy and viral suppression ?. Journal of Acquired Immune Deficiency Syndromes - JAIDS, 2019, 80 (5), pp.574-584. ⟨10.1097/QAI.0000000000001954⟩. ⟨inserm-02070251⟩
175 Consultations
344 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More