PMID- 29135577
OWN - NLM
STAT- MEDLINE
DCOM- 20180716
LR  - 20180716
IS  - 1473-5571 (Electronic)
IS  - 0269-9370 (Linking)
VI  - 32
IP  - 2
DP  - 2018 Jan 14
TI  - Protease inhibitors and preterm delivery: another piece in the puzzle.
PG  - 243-252
LID - 10.1097/QAD.0000000000001694 [doi]
AB  - BACKGROUND: Questions remain regarding preterm delivery (PTD) risk in
      HIV-infected women on antiretroviral therapy (ART), including the role of
      ritonavir (RTV)-boosted protease inhibitors, timing of ART initiation and immune 
      status. METHODS: We examined data from the UK/Ireland National Study of HIV in
      Pregnancy and Childhood on women with HIV delivering a singleton live infant in
      2007-2015, including those pregnancies receiving RTV-boosted protease
      inhibitor-based (n = 4184) or nonnucleoside reverse transcriptase
      inhibitors-based regimens (n = 1889). We conducted logistic regression analysis
      adjusted for risk factors associated with PTD and stratified by ART at conception
      and CD4 cell count to minimize bias by indication for treatment and to assess
      whether PTD risk differs by ART class and specific drug combinations. RESULTS:
      Among women conceiving on ART, lopinavir/RTV was associated with increased PTD
      risk in those with CD4 cell count 350 cells/mul or less [odds ratio 1.99 (1.02,
      3.85)] and with CD4 cell count more than 350 cells/mul [odds ratio 1.61 (1.07,
      2.43)] vs. women on nonnucleoside reverse transcriptase inhibitors-based (mainly 
      efavirenz and nevirapine) regimens in the same CD4 subgroup. Associations between
      other protease inhibitor-based regimens (mainly atazanavir and darunavir) and PTD
      risk were complex. Overall, PTD risk was higher in women who conceived on ART,
      had low CD4 cell count and were older. No trend of association of PTD with
      tenofovir or any specific drug combinations was observed. CONCLUSION: Our data
      support a link between the initiation of RTV-boosted/lopinavir-based ART
      preconception and PTD in subsequent pregnancies, with implications for treatment 
      guidelines. Continued monitoring of PTD risk is needed as increasing numbers of
      pregnancies are conceived on new drugs.
FAU - Favarato, Graziella
AU  - Favarato G
AD  - Population, Policy and Practice Programme, UCL Great Ormond Street Institute of
      Child Health, University College London.
FAU - Townsend, Claire L
AU  - Townsend CL
AD  - Population, Policy and Practice Programme, UCL Great Ormond Street Institute of
      Child Health, University College London.
FAU - Bailey, Heather
AU  - Bailey H
AD  - Population, Policy and Practice Programme, UCL Great Ormond Street Institute of
      Child Health, University College London.
FAU - Peters, Helen
AU  - Peters H
AD  - Population, Policy and Practice Programme, UCL Great Ormond Street Institute of
      Child Health, University College London.
FAU - Tookey, Pat A
AU  - Tookey PA
AD  - Population, Policy and Practice Programme, UCL Great Ormond Street Institute of
      Child Health, University College London.
FAU - Taylor, Graham P
AU  - Taylor GP
AD  - Section of Virology, Faculty of Medicine, Imperial College London, London, UK.
FAU - Thorne, Claire
AU  - Thorne C
AD  - Population, Policy and Practice Programme, UCL Great Ormond Street Institute of
      Child Health, University College London.
LA  - eng
PT  - Journal Article
PL  - England
TA  - AIDS
JT  - AIDS (London, England)
JID - 8710219
RN  - 0 (Anti-Retroviral Agents)
RN  - 0 (HIV Protease Inhibitors)
RN  - 2494G1JF75 (Lopinavir)
RN  - O3J8G9O825 (Ritonavir)
SB  - IM
SB  - X
MH  - Adult
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - Antiretroviral Therapy, Highly Active/*methods
MH  - Female
MH  - HIV Infections/*drug therapy
MH  - HIV Protease Inhibitors/*therapeutic use
MH  - Humans
MH  - Infant, Newborn
MH  - Ireland/epidemiology
MH  - Lopinavir/therapeutic use
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/*drug therapy
MH  - Premature Birth/*epidemiology
MH  - Risk Assessment
MH  - Ritonavir/*therapeutic use
MH  - United Kingdom/epidemiology
EDAT- 2017/11/15 06:00
MHDA- 2018/07/17 06:00
CRDT- 2017/11/15 06:00
PHST- 2017/11/15 06:00 [pubmed]
PHST- 2018/07/17 06:00 [medline]
PHST- 2017/11/15 06:00 [entrez]
AID - 10.1097/QAD.0000000000001694 [doi]
PST - ppublish
SO  - AIDS. 2018 Jan 14;32(2):243-252. doi: 10.1097/QAD.0000000000001694.