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Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
An increasing number of HIV-infected women of childbearing age are initiating antiretroviral therapy (ART) worldwide. This review aims to discuss updated data of the eligible ART regimens and their role in inducing birth defects in utero. Zidovudine and lamivudine plus a non-nucleoside reverse-trans...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove Medical Press
2013
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738258/ https://www.ncbi.nlm.nih.gov/pubmed/23943659 http://dx.doi.org/10.2147/HIV.S15542 |
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author | Prestes-Carneiro, Luiz Euribel |
author_facet | Prestes-Carneiro, Luiz Euribel |
author_sort | Prestes-Carneiro, Luiz Euribel |
collection | PubMed |
description | An increasing number of HIV-infected women of childbearing age are initiating antiretroviral therapy (ART) worldwide. This review aims to discuss updated data of the eligible ART regimens and their role in inducing birth defects in utero. Zidovudine and lamivudine plus a non-nucleoside reverse-transcriptase inhibitor or protease inhibitor (PI) is the first-line regimen applied. The role of zidovudine exposition monotherapy or associated with other ART in inducing birth defects remains inconclusive. The main organ systems involved are genitourinary and cardiovascular. For HIV-infected pregnant women, World Health Organization (WHO) guidelines up to 2010 recommend the same group of drugs that are prescribed to nonpregnant women. The exception is efavirenz, which has been associated with an increase in the risk of teratogenicity. Increased rates of birth defects were found in large cohorts and computational studies conducted recently in infants exposed to efavirenz-containing regimens. The combination of zidovudine and lamivudine and lopinavir/ritonavir is one of the most used ART regimens for prevention of mother-to-child-transmission. Conflicting data about the role of PI exposure in utero and birth defects have been reported. However, a reduced number of studies evaluating the role of PI in inducing birth defects in women are available. An association between prematurity and PI exposure in pregnancy was extensively described. Some questions arise due to the tendency of initiating ART early in the life of HIV-infected individuals or those at risk of infection. Longtime exposure to different ART regimens and the potential effect of birth-defect induction in pregnancy are not completely understood. Developing regions harbor the highest numbers of women of reproductive age exposed to ART. Most of the largest and expressive data come from developed countries, and could not be sufficiently representative of pregnant women living in developing countries. |
format | Online Article Text |
id | pubmed-3738258 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-37382582013-08-13 Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data Prestes-Carneiro, Luiz Euribel HIV AIDS (Auckl) Review An increasing number of HIV-infected women of childbearing age are initiating antiretroviral therapy (ART) worldwide. This review aims to discuss updated data of the eligible ART regimens and their role in inducing birth defects in utero. Zidovudine and lamivudine plus a non-nucleoside reverse-transcriptase inhibitor or protease inhibitor (PI) is the first-line regimen applied. The role of zidovudine exposition monotherapy or associated with other ART in inducing birth defects remains inconclusive. The main organ systems involved are genitourinary and cardiovascular. For HIV-infected pregnant women, World Health Organization (WHO) guidelines up to 2010 recommend the same group of drugs that are prescribed to nonpregnant women. The exception is efavirenz, which has been associated with an increase in the risk of teratogenicity. Increased rates of birth defects were found in large cohorts and computational studies conducted recently in infants exposed to efavirenz-containing regimens. The combination of zidovudine and lamivudine and lopinavir/ritonavir is one of the most used ART regimens for prevention of mother-to-child-transmission. Conflicting data about the role of PI exposure in utero and birth defects have been reported. However, a reduced number of studies evaluating the role of PI in inducing birth defects in women are available. An association between prematurity and PI exposure in pregnancy was extensively described. Some questions arise due to the tendency of initiating ART early in the life of HIV-infected individuals or those at risk of infection. Longtime exposure to different ART regimens and the potential effect of birth-defect induction in pregnancy are not completely understood. Developing regions harbor the highest numbers of women of reproductive age exposed to ART. Most of the largest and expressive data come from developed countries, and could not be sufficiently representative of pregnant women living in developing countries. Dove Medical Press 2013-08-01 /pmc/articles/PMC3738258/ /pubmed/23943659 http://dx.doi.org/10.2147/HIV.S15542 Text en © 2013 Prestes-Carneiro, publisher and licensee Dove Medical Press Ltd This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. |
spellingShingle | Review Prestes-Carneiro, Luiz Euribel Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
title | Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
title_full | Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
title_fullStr | Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
title_full_unstemmed | Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
title_short | Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
title_sort | antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738258/ https://www.ncbi.nlm.nih.gov/pubmed/23943659 http://dx.doi.org/10.2147/HIV.S15542 |
work_keys_str_mv | AT prestescarneiroluizeuribel antiretroviraltherapypregnancyandbirthdefectsadiscussionontheupdateddata |