학술논문
Adverse Pregnancy Outcomes Among Women Who Conceive on Antiretroviral Therapy
Document Type
article
Author
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; Losso, M; Machado, E; de Menezes, J; Duarte, G; Sperhacke, R; Pinto, J; Kreitchman, R; Santos, B; Wei, L; Pape, JW; Sanchez, J; Sandoval, E; Chokephaibulkit, K; Achalapong, J; Halue, G; Yuthavisuthi, P; Prommas, S; Bowonwatanuwong, C; Sirisanthana, V; Riddler, S; Kumar, P; Shearer, W; Yogev, R; Scott, G; Spector, S; Cunningham, C; Bamji, M; Cooper, E; Wiznia, A; Hitti, J; Emmanuel, P; Scott, R; Acevedo, M; Nachman, S; Jones, T; Rana, S; Keller, M; Stek, A; Rathore, M; McFarland, E; Puga, A; Agwu, A; Chen, T; Van Dyke, R; Deville, J; Purswani, M; Tebas, P; Flynn, P; Fischl, M
Source
Clinical Infectious Diseases. 68(2)
Subject
Language
Abstract
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.