Traditional, Alternative Combo ART Regimens Compared in Pregnant Women

The study used a cohort of 274 pregnant women with HIV and compared their viral load near delivery
The study used a cohort of 274 pregnant women with HIV and compared their viral load near delivery

This article is written live from ID Week 2017 Annual Meeting in San Diego, CA. MPR will be reporting news on the latest findings from leading experts in infectious diseases. Check back for more news from IDWeek 2017.


SAN DIEGO—At IDWeek 2017, Danielle Tate, MD, from the University of Tennessee, Memphis, TN, and coauthors presented that their study cohort of pregnant women with HIV achieved similar rate of HIV viral load <1,000 copies/mL near delivery after receiving traditional or alternative combination antiretroviral therapy (cART) regimens.

The rate of maternal HIV transmission to the child is reduced with cART from 25% at baseline to <2% when the viral load is <1,000 copies/mL. Traditional cART consists of 2 nucleoside reverse transcriptase inhibitors (NRTI) + 1 protease inhibitor (PI). Evidence of alternative cART regimens—consisting of either an integrase strand transfer inhibitor (INSTI) or a non-NRTI—in reducing viral load during pregnancy is limited.

Dr. Tate and team performed a prospective cohort study of 274 pregnant women infected with HIV to compare their viral load near delivery after receiving ‘traditional' cART (2 NRTIs + 1 PI) or ‘alternative' cART (2 NRTIs + 1 INSTI or 1 non-NRTI).

“Women were included if they had at least 2 viral load [VL] before and after intervention obtained during pregnancy. Our primary outcome was the rate of VL <1,000 copies/mL near delivery.” Treatment with traditional cART lasted 17 weeks and alternative cART lasted 18 weeks.

The data showed similar rates of viral load <1,000 copies/mL near delivery for women who received traditional cART vs. the alternative cART (77.6% vs. 85.6%; P=0.2765, RR 1.474, 95% CI: 0.733–2.967) after adjusting for confounding variables. There were more women in the alternative cART group that exhibited undetectable viral load near delivery than the traditional cART group (66.9% vs. 46.1%; P=0.0103, RR 2.002, 95% CI: 1.178–3.403).

Maternal-to-child transmission was observed in 5 women (1.8%): 4 in the alternative cART group and 1 in the traditional cART group.

Both cART regimens resulted in comparable rates of HIV viral load <1,000 copies/mL near delivery in the cohort of pregnant women, the authors concluded. They called for more research to confirm the findings.  

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Reference:

Tate, D. Comparison of two Antiretroviral Therapy Regimens in Human Immunodeficiency Virus (HIV-) Infected Pregnant Women; Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org