The association between antiretroviral therapy and early placental function: a cohort study

Abstract

Objective: To evaluate the association of antiretroviral therapy (ART) type and duration of exposure with early placental function using biomarkers of aneuploidy screening.

Study design: Three hundred thirty-eight pregnant women living with HIV were enrolled in two Canadian centers. Multiple linear regressions were performed adjusting for confounding factors (race, age, gestational age, body mass index, parity, smoking, and fetal sex).

Results: Women receiving ART had significantly increased second trimester alpha-fetoprotein (AFP) levels (β = 0.147, 95% CI = [0.067–0.227] for protease inhibitor-based ART and β = 0.176, 95% CI = [0.080–0.272] for ART without protease inhibitor) compared to women who received no treatment. However, there was no significant association between ART type and the levels of free β-human chorionic gonadotrophin (β-hCG), pregnancy-associated plasma protein-A (first trimester), unconjugated estriol, total hCG, and inhibin A (second trimester). No significant association was shown between biomarker levels and duration of ART exposure.

Conclusion: Early placental function does not appear to be significantly affected by ART, except for AFP.

Keywords:

• AFP
• antiretroviral therapy
• free β-hCG
• HIV
• inhibin-A
• PAPP-A
• placental function
• pregnancy
• unconjugated estriol

Acknowledgments

We thank everyone at the CHU Sainte-Justine AIDS Center (CMIS), the Oak Tree Clinic staff at BC Women’s Hospital (Vancouver, BC, USA) and all the women from both cohorts for their contributions to the success of this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the AIDS and Infectious Disease Network (Sida/MI) of the Fonds de Recherche du Québec – Santé (FRQS). IB and HT hold a salary award (chercheur-boursier) from the Fonds de la recherche du Québec – Santé (FRQS) and HT has a new investigator salary award from the Canadian Institutes of Health Research (CIHR).