Traditional, alternative HIV regimens yield similar results in pregnancy
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Traditional combined antiretroviral therapy — or cART — and alternative cART were similarly effective in treating HIV-infected pregnant women, with similar rates of vertical transmission, according to a study.
Women also had similar viral loads across treatment groups, according to a poster presented at the Infectious Diseases Society for Obstetrics and Gynecology Annual Meeting.
“Prior to and during the study period, new reports were being published on the fast clearance of HIV viral load in pregnant and nonpregnant individuals with a regimen containing integrase strand transfer inhibitors (INSTI) compared to the traditional two nucleoside reverse transcriptase inhibitor (NRTI) plus 1 protease inhibitor (PI)-based [cART],” Luis M. Gomez, MD, MScE, senior investigator of the study and a perinatologist specializing in maternal-fetal medicine and OB/GYN at the Inova Health System in Fairfax, Virginia, told Healio.
“Because many of our patients had state insurance that approved only the PI-based cART, we wanted to study if their rate of HIV clearance to undetectable viral load (VL) would be impaired if not being able to afford an INSTI regimen,” Gomez said. “Also, because vaginal delivery was allowed if the VL was less than 1,000 copies/mL near delivery, we wanted to compare if being on different treatment regimens would impact on their chances of being candidates for vaginal delivery.”
Gomez and colleagues analyzed the VL of 274 pregnant women with HIV who received care at the HIV High-Risk Obstetric Clinic at The University of Tennessee Health Science Center in Memphis between 2010 and 2017. All participants in the prospective study provided at least two VLs during pregnancy, before and after cART.
The researchers also examined the rate of undetectable VL near delivery and the rate of vertical transmission.
Overall, 118 (43%) participants received the traditional PI-based cART and 156 (57%) received the alternative INSTI-based regimen. When adjusting for confounders, the rate of VL less than 1,000 copies/mL near delivery was similar between women receiving traditional and alternative cART (77.6% vs. 85.6%).
Gomez noted that the rate of undetected VL near delivery was similar between the groups. Both groups had two cases of vertical transmission.
The findings show that for both regimens, patients who comply with treatment and achieve a VL of less than 1,000 copies/mL would be able to undergo a trial of labor, Gomez said.
He also noted that the PI-based cART was covered by the state’s Medicaid program, while INSTI-based cART was covered by private insurance. According to Gomez, INSTI-based cART would cost between $2,000 and $2,500 monthly if patients were uninsured.
Because most participants in the study were Black, Gomez suggested future research investigate outcomes of traditional and alternative cART in other races and ethnicities.