scholarly journals Safety and Tolerability of Antiretrovirals during Pregnancy

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Adriana Weinberg ◽  
Jeri Forster-Harwood ◽  
Jill Davies ◽  
Elizabeth J. McFarland ◽  
Jennifer Pappas ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Adverse Events ◽  
Pregnant Women ◽  
Combination Antiretroviral Therapy ◽  
Fetal Demise ◽  
Maternal Deaths ◽  
Grade 3 ◽  
Mother To Child ◽  
Hiv 1 ◽  
In Pregnancy

Combination antiretroviral therapy (CART) dramatically decreases mother-to-child HIV-1 transmission (MTCT), but maternal adverse events are not infrequent. A review of 117 locally followed pregnancies revealed 7 grade ≥3 AEs possibly related to antiretrovirals, including 2 hematologic, 3 hepatic, and 2 obstetric cholestasis cases. A fetal demise was attributed to obstetric cholestasis, but no maternal deaths occurred. The drugs possibly associated with these AE were zidovudine, nelfinavir, lopinavir/ritonavir, and indinavir. AE or intolerability required discontinuation/substitution of nevirapine in 16% of the users, zidovudine in 10%, nelfinavir in 9%, lopinavir/ritonavir in 1%, but epivir and stavudine in none. In conclusion, nevirapine, zidovudine, and nelfinavir had the highest frequency of AE and/or the lowest tolerability during pregnancy. Although nevirapine and nelfinavir are infrequently used in pregnancy at present, zidovudine is included in most MTCT preventative regimens. Our data emphasize the need to revise the treatment recommendations for pregnant women to include safer and better-tolerated drugs.

scholarly journals Antenatal Atazanavir: A Retrospective Analysis of Pregnancies Exposed to Atazanavir

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Miriam Samuel ◽  
Daniel Bradshaw ◽  
Melissa Perry ◽  
Sum Yee Chan ◽  
Rageshri Dhairyawan ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Medical Records ◽  
Combination Antiretroviral Therapy ◽  
Child Transmission ◽  
First Line ◽  
Gastrointestinal Intolerance ◽  
Few Data ◽  
Mother To Child ◽  
In Pregnancy ◽  
New Onset

Introduction.There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy.Methods.A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010.Results.There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), “preconception” atazanavir exposure; 27 started atazanavir-based cART as “first-line” during the pregnancy; and 29 “switched” to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman.Conclusions.These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy.

scholarly journals Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

2020 ◽  
Vol 9 (1) ◽  
pp. 81-92
Author(s):  
Cedrina L. Calder ◽  
Heather O ◽  
Mohammad Tabatabai ◽  
Celia J. Maxwell ◽  
Salisha Marryshow ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Secondary Analysis ◽  
Self Report ◽  
Hiv Positive ◽  
Combination Antiretroviral Therapy ◽  
North Central ◽  
Hiv Positive Women ◽  
Mother To Child

Objective: Adherence to combination antiretroviral therapy (ART) among pregnant women is essential to attaining the goal of eliminating mother-to-child HIV transmission. The objective of this study was to determine which factors affect adherence to ART among HIV-positive women enrolled in a large prevention of mother-to-child HIV transmission (PMTCT) trial in rural north-central Nigeria. Methods: The parent study included 372 HIV-positive pregnant women enrolled in a cluster-randomized control trial conducted at 12 health facilities in Nigeria between 2013 and 2015. This secondary analysis included HIV-positive women (and their infants) from the original trial with documented adherence data (n=210, 56.5%). The primary outcome was maternal adherence to ART, determined by self-report and based on the visual analogue scale (VAS) of a validated medication adherence tool. Participants with a VAS score of ? 95% were classified as adherent. We employed multivariate logistic regression to evaluate the predictors of maternal ART adherence in the study sample. Results: Approximately 61.0% of study participants (128/210) were adherent to ART. The majority of adherent participants (62.5%, 80/128) were enrolled in the trial intervention arm. The most common cited response for non-adherence was fear of status disclosure. Adherence to ART was associated with study arm (intervention arm vs. control arm, adjusted Odds Ratio (aOR) [95% CI]: 16.95 [5.30-54.23]), maternal ethnicity (Gwari vs. Other, aOR = 0.13 [0.05-0.38]), and partner HIV status (HIV-positive vs. unknown, aOR = 3.14 [1.22-8.07]). Conclusion and Global Health Implications: Adherence to ART among a cohort of pregnant women enrolled in a PMTCT trial in rural North-Central Nigeria was associated with trial arm, maternal self- reported ethnicity, and partner

Is Intrapartum Intravenous Zidovudine for Prevention of Mother-to-Child HIV-1 Transmission Still Useful in the Combination Antiretroviral Therapy Era?

2013 ◽  
Vol 57 (6) ◽  
pp. 903-914 ◽  
Author(s):  
Nelly Briand ◽  
Josiane Warszawski ◽  
Laurent Mandelbrot ◽  
Catherine Dollfus ◽  
Emmanuelle Pannier ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Combination Antiretroviral Therapy ◽  
Mother To Child ◽  
Hiv 1

scholarly journals HIV‐1 Reverse Transcriptase Connection Domain Mutations: Dynamics of Emergence and Implications for Success of Combination Antiretroviral Therapy

2010 ◽  
Vol 51 (5) ◽  
pp. 620-628 ◽  
Author(s):  
Viktor von Wyl ◽  
Maryam Ehteshami ◽  
Lisa M. Demeter ◽  
Philippe Bürgisser ◽  
Monique Nijhuis ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Reverse Transcriptase ◽  
Combination Antiretroviral Therapy ◽  
Hiv 1
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