Cargando…
Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy
As antiretroviral therapy (ART) expands in resource-limited settings, understanding the impact of ART on pregnancy outcomes is critical. We analyzed women who became pregnant on ART while enrolled in a clinical trial (HPTN 052, ACTG A5208, and ACTG A5175); the majority of women were from Africa, wit...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051581/ https://www.ncbi.nlm.nih.gov/pubmed/30020964 http://dx.doi.org/10.1371/journal.pone.0199555 |
_version_ | 1783340544824442880 |
---|---|
author | Stringer, Elizabeth M. Kendall, Michelle A. Lockman, Shahin Campbell, Thomas B. Nielsen-Saines, Karin Sawe, Fred Cu-uvin, Susan Wu, Xingye Currier, Judith S. |
author_facet | Stringer, Elizabeth M. Kendall, Michelle A. Lockman, Shahin Campbell, Thomas B. Nielsen-Saines, Karin Sawe, Fred Cu-uvin, Susan Wu, Xingye Currier, Judith S. |
author_sort | Stringer, Elizabeth M. |
collection | PubMed |
description | As antiretroviral therapy (ART) expands in resource-limited settings, understanding the impact of ART on pregnancy outcomes is critical. We analyzed women who became pregnant on ART while enrolled in a clinical trial (HPTN 052, ACTG A5208, and ACTG A5175); the majority of women were from Africa, with a median age of 29 years. Eligible women were on ART at conception and had a documented date of a last menstrual period and a pregnancy outcome. The primary outcome was non-live birth (stillbirth; spontaneous abortion; elective termination; or ectopic pregnancy) versus live birth. Preterm birth (<37 weeks completed gestation) was a secondary outcome. We used Cox proportional hazards regression models with time-varying covariates. 359 women became pregnant, of whom 253 (70%) met inclusion criteria: 127 (50%) were on NNRTI-based ART, 118 (47%) on PI-based ART, and 8 (3%) on 3-NRTIs at conception. There were 160 (63%) live births (76 term and 84 preterm), 11 (4%) stillbirths, 51 (20%) spontaneous abortions, 28 (11%) elective terminations, and 3 (1%) ectopic pregnancies. In multivariable analysis adjusted for region, parent study, and pre-pregnancy ART class, only older age was associated with increased hazard of preterm birth [HR: 2.49 for age 25–30 years; 95% CI: 1.18–5.26; p = 0.017]. Women conceiving on ART had high rates of preterm birth and other adverse pregnancy outcomes. Despite the benefits of ART, studies designed to investigate the effects of preconception ART on pregnancy outcomes are needed. |
format | Online Article Text |
id | pubmed-6051581 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-60515812018-07-27 Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy Stringer, Elizabeth M. Kendall, Michelle A. Lockman, Shahin Campbell, Thomas B. Nielsen-Saines, Karin Sawe, Fred Cu-uvin, Susan Wu, Xingye Currier, Judith S. PLoS One Research Article As antiretroviral therapy (ART) expands in resource-limited settings, understanding the impact of ART on pregnancy outcomes is critical. We analyzed women who became pregnant on ART while enrolled in a clinical trial (HPTN 052, ACTG A5208, and ACTG A5175); the majority of women were from Africa, with a median age of 29 years. Eligible women were on ART at conception and had a documented date of a last menstrual period and a pregnancy outcome. The primary outcome was non-live birth (stillbirth; spontaneous abortion; elective termination; or ectopic pregnancy) versus live birth. Preterm birth (<37 weeks completed gestation) was a secondary outcome. We used Cox proportional hazards regression models with time-varying covariates. 359 women became pregnant, of whom 253 (70%) met inclusion criteria: 127 (50%) were on NNRTI-based ART, 118 (47%) on PI-based ART, and 8 (3%) on 3-NRTIs at conception. There were 160 (63%) live births (76 term and 84 preterm), 11 (4%) stillbirths, 51 (20%) spontaneous abortions, 28 (11%) elective terminations, and 3 (1%) ectopic pregnancies. In multivariable analysis adjusted for region, parent study, and pre-pregnancy ART class, only older age was associated with increased hazard of preterm birth [HR: 2.49 for age 25–30 years; 95% CI: 1.18–5.26; p = 0.017]. Women conceiving on ART had high rates of preterm birth and other adverse pregnancy outcomes. Despite the benefits of ART, studies designed to investigate the effects of preconception ART on pregnancy outcomes are needed. Public Library of Science 2018-07-18 /pmc/articles/PMC6051581/ /pubmed/30020964 http://dx.doi.org/10.1371/journal.pone.0199555 Text en © 2018 Stringer et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Stringer, Elizabeth M. Kendall, Michelle A. Lockman, Shahin Campbell, Thomas B. Nielsen-Saines, Karin Sawe, Fred Cu-uvin, Susan Wu, Xingye Currier, Judith S. Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy |
title | Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy |
title_full | Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy |
title_fullStr | Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy |
title_full_unstemmed | Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy |
title_short | Pregnancy outcomes among HIV-infected women who conceived on antiretroviral therapy |
title_sort | pregnancy outcomes among hiv-infected women who conceived on antiretroviral therapy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051581/ https://www.ncbi.nlm.nih.gov/pubmed/30020964 http://dx.doi.org/10.1371/journal.pone.0199555 |
work_keys_str_mv | AT stringerelizabethm pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT kendallmichellea pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT lockmanshahin pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT campbellthomasb pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT nielsensaineskarin pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT sawefred pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT cuuvinsusan pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT wuxingye pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy AT currierjudiths pregnancyoutcomesamonghivinfectedwomenwhoconceivedonantiretroviraltherapy |