HealthDay News — For HIV-infected pregnant women, antiretroviral therapy (ART) is associated with significantly lower rates of early HIV transmission, but with a higher risk of adverse maternal and neonatal outcomes, according to a study published in the November 3 issue of the New England Journal of Medicine.

Mary G. Fowler, MD, MPH, from the Johns Hopkins University School of Medicine in Baltimore, and colleagues randomized 3,490 HIV-infected women at 14 or more weeks of gestation with CD4 counts of at least 350 cells/mm³ to zidovudine and single-dose nevirapine plus a one-to-two-week postpartum “tail” of tenofovir and emtricitabine (zidovudine alone); zidovudine, lamivudine, and lopinavir-ritonavir (zidovudine-based ART); or tenofovir, emtricitabine, and lopinavir-ritonavir (tenofovir-based ART).

The researchers found that, compared to zidovudine alone, the rate of transmission was significantly lower with ART (0.5% in the combined ART groups versus 1.8%). Compared with zidovudine alone, zidovudine-based ART was associated with a significantly higher rate of maternal grade 2 to 4 adverse events (P=0.008), and tenofovir-based ART correlated with an increased rate of grade 2 to 4 abnormal blood chemical values (P=0.03). Birth weight <2,500g occurred more often with zidovudine- and tenofovir-based ART than with zidovudine alone.

“Antenatal ART resulted in significantly lower rates of early HIV transmission than zidovudine alone but a higher risk of adverse maternal and neonatal outcomes,” the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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