Comparison of two combined antiretroviral treatment regimens in the management of HIV in pregnancy: an observational study

Abstract

Objective

Combined antiretroviral therapy (cART) in pregnancy traditionally included two nucleoside reverse transcriptase inhibitors plus 1 protease inhibitor (PI). Recently, integrase strand transfer inhibitors (INSTI) have been approved for use in pregnancy. We sought to compare the rate of undetectable VL near delivery in pregnant HIV-infected women receiving INSTI-based versus PI-based cART.

Material and methods

Prospective cohort study (January 2010–March 2017) of pregnant HIV-infected pregnancies receiving care in a single obstetric infectious disease clinic. Included pregnancies (total = 171; INSTI − group = 111, PI − group = 60) had at least 2 VL (before and after intervention) during pregnancy. The primary outcome was the rate of undetectable VL near delivery.

Results

We found comparable rates of undetectable HIV VL near delivery in pregnancies treated with INSTI-cART (74/111, 66.7%) compared to PI-cART (34/60, 56.7%; [adjusted p = .116, RR 1.26, 95% CI 0.92–2.59]). Compared to the PI-group, pregnancies in the INSTI-group showed lower median HIV VL near delivery (20 versus 50 copies/mL; adjusted p = .0454) and greater VL reduction (adjusted p = .0185). There were 3/171 (1.75%) infants diagnosed with HIV, 1 in the INSTI-group and 2 in the PI-group (p = .5635, RR 0.51, 95% CI 0.10–2.53).

Conclusion

Pregnant HIV-infected women receiving either INSTI- or PI-based cART achieved comparable rates of undetectable HIV VL near delivery with similar perinatal transmission.

Keywords:

• cART
• HIV RNA levels
• integrase inhibitor
• mother-to-child transmission
• protease inhibitor

Acknowledgments

We thank the support of Dr. Elizabeth Tolley and Dr. Simonne Nouer in their critical review of our research, Ms. Ebony Smith, and all the members of the Infectious Disease Obstetric Clinic at the University of Tennessee Health Science Center.

Disclosure statement

No potential conflict of interest was reported by the authors.