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Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception

Huntington, SE; Bansi, LK; Thorne, C; Anderson, J; Newell, ML; Taylor, GP; Pillay, D; ... National Study of HIV in Pregnancy and Childhood, ; + view all (2011) Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception. AIDS , 25 (13) 1647 - 1655. 10.1097/QAD.0b013e32834982af. Green open access

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Abstract

Objectives: To describe antiretroviral therapy (ART) use and clinical status, at start of and during pregnancy, for HIV-positive women receiving ART at conception, including the proportion conceiving on drugs (efavirenz and didanosine) not recommended for use in early pregnancy.Methods: Women with a pregnancy resulting in a live-birth after 1995 (n = 1537) were identified in an observational cohort of patients receiving HIV care at 12 clinics in the UK by matching records with national pregnancy data. Treatment and clinical data were analysed for 375 women conceiving on ART, including logistic regression to identify factors associated with changing regimen during pregnancy.Results: Of the 375 women on ART, 39 (10%) conceived on dual therapy, 306 (82%) on triple therapy and 30 (8%) on more than three drugs. In total, 116 (31%) women conceived on a regimen containing efavirenz or didanosine (69 efavirenz, 54 didanosine, seven both). Overall, 38% (143) changed regimen during pregnancy, of whom 44% (n = 51) had a detectable viral load around that time. Detectable viral load was associated with increased risk of regimen change [adjusted odds ratio 2.97, 95% confidence interval (CI) (1.70-5.19)], while women on efavirenz at conception were three times more likely to switch than women on other drugs [3.40, (1.84-6.25)]. Regimen switching was also associated with year at conception [0.89, (0.83-0.96)].Conclusion: These findings reinforce the need for careful consideration of ART use among women planning or likely to have a pregnancy in order to reduce viral load before pregnancy and avoid drugs not recommended for early antenatal use. (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Type: Article
Title: Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0b013e32834982af
Publisher version: http://dx.doi.org/10.1097/QAD.0b013e32834982af
Language: English
Additional information: This is a non-final version of an article published in final form in Huntington, SE and Bansi, LK and Thorne, C and Anderson, J and Newell, ML and Taylor, GP and Pillay, D and Hill, T and Tookey, PA and Sabin, CA and UK Collaborative HIV Cohort U, and Natl Study HIV Pregnancy Childho, (2011) Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception. AIDS , 25 (13) 1647 - 1655.
Keywords: antiretroviral agents, antiretroviral therapy, HIV, pregnancy, United Kingdom, INFECTED WOMEN, ASSOCIATION GUIDELINES, MULTICENTER COHORT, EFAVIRENZ, EXPOSURE, OUTCOMES, IRELAND, UK, TRANSMISSION, MANAGEMENT
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Pop, Policy and Practice Prog
URI: http://discovery.ucl.ac.uk/id/eprint/1311243
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