Risks to babies of mothers with HIV from three antiretroviral regimens appear to be lowApril 25, 2018
- There was no difference in risk for adverse birth outcomes, including premature delivery and death of the newborn baby between three antiretroviral drug regimens taken by pregnant women with HIV: TDF-FTC-ATV/r, TDF-FTC-LPV/r, and ZDV-3TC-LPV/r
- Researchers recommend that use of TDF-FTC-LPV/r in pregnant women with HIV continue to be limited due to risks found by a previous study.
Boston, MA - The risk for preterm birth and early infant death is similar for three antiretroviral drug regimens taken by pregnant women with HIV according to a new study from Harvard T.H. Chan School of Public Health.
The study will be published in the April 26, 2018 issue of the New England Journal of Medicine.
Global use of three-drug antiretroviral therapy (ART) by pregnant women with HIV has reduced the risk of mother-to-child transmission of the virus to less than 1%, but an earlier trial, the PROMISE trial, had raised concerns about the safety of one regimen.
In that trial, it was found that women in sub-Saharan Africa and India who took TDF-FTC-LPV/r (tenofovir disoproxil fumarate, emtricitabine, and ritonavir-boosted lopinavir) had infants at greater risk for very premature birth (less than 34 weeks of gestation) and death within 14 days after delivery than those taking ZDV-3TC-LPV/r (zidovudine, lamivudine, and ritonavir-boosted lopinavir).
Because the World Health Organization recommends a once-daily TDF-FTC-based regimen as first-line therapy for all HIV-infected adults, including pregnant women, the Harvard Chan researchers wanted to compare the risks posed by the two regimens studied in the PROMISE trial and an additional regimen using TDF-FTC and a different protease inhibitor (drug that prevents viral replication) called ATV/r (ritonavir-boosted atazanavir).
The study analyzed data from 1,621 mothers in two U.S.-based cohort studies--the Surveillance Monitoring for ART Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS) and the P1025 study of the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network--who had started taking one of the three drug combinations before or during pregnancy.
The researchers found that all three regimens pose similar risks for adverse birth outcomes. In addition, women using TDF-FTC-ATV/r had lower risks of preterm birth and low birth weight than those using TDF--FTC-LPV/r, and a similar or lower risk than those using ZDV-3TC-LPV/r. However, the authors noted that TDF-FTC-LPV/r is rarely used in the United States, which may have limited the statistical accuracy of the study to identify risks associated with this combination.
"It was reassuring to see that the use of TDF-FTC-ATV/r during pregnancy was not associated with an increased risk of poor birth outcomes in our study," said first author Kathryn Rough, who conducted the study as a doctoral student at the School. "But based on the earlier results from the PROMISE trial, it may be wise to continue limiting the use of TDF-FTC-LPV/r in pregnant women with HIV."
The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases (NIAID), the Office of AIDS Research, the National Institute of Mental Health (NIMH), the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart, Lung, and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard T.H. Chan School of Public Health (HD052102) and the Tulane University School of Medicine (HD052104). Support for the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network was provided by the NIAID of the National Institutes of Health (NIH) under award numbers UM1AI068632 (IMPAACT LOC), UM1AI068616 (IMPAACT SDMC), and UM1AI106716 (IMPAACT LC), with cofunding from the NICHD and the NIMH. Rough was additionally supported by grant number T32 AI007433 from the NIAID.
"Birth Outcomes for Pregnant Women with HIV Using Tenofovir-Emtricitabine," Kathryn Rough, George R. Seage, III, Paige L. Williams, Sonia Hernandez-Diaz, Yanling Huo, Ellen G. Chadwick, Judith S. Currier, Risa M. Hoffman, Emily Barr, David E. Shapiro, and Kunjal Patel, NEJM, online April 26, 2018, doi: DOI: 10.1056/NEJMoa1701666
Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.
Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives--not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.
Harvard T.H. Chan School of Public Health
Related Hiv Articles:
A new study finds defective HIV proviruses, long thought to be harmless, produce viral proteins and distract the immune system from killing intact proviruses needed to reduce the HIV reservoir and cure HIV.
Almost 30,000 newly diagnosed HIV infections were reported by the 31 European Union and European Economic Area (EU/EEA) countries in 2015, according to data published today by ECDC and the WHO Regional Office for Europe.
A new study led by researchers at Massachusetts General Hospital finds that cigarette smoking substantially reduces the lifespan of people living with HIV in the US, potentially even more than HIV itself.
HIV-positive individuals who smoke cigarettes may be more likely to die from smoking-related disease than the infection itself, according to a new study published in the Journal of Infectious Diseases.
An estimated 1.2 million people live with HIV in the United States, with nearly 13 percent being unaware of their infection.
A major new analysis from the Global Burden of Disease 2015 study, published today in The Lancet HIV journal, reveals that although deaths from HIV/AIDS have been steadily declining from a peak in 2005, 2.5 million people worldwide became newly infected with HIV in 2015, a number that hasn't changed substantially in the past 10 years.
Investigators from the National Institutes of Health have discovered that cells from HIV-infected people whose virus is suppressed with treatment harbor defective HIV DNA that can nevertheless be transcribed into a template for producing HIV-related proteins.
Among nearly 900 serodifferent (one partner is HIV-positive, one is HIV-negative) heterosexual and men who have sex with men couples in which the HIV-positive partner was using suppressive antiretroviral therapy and who reported condomless sex, during a median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission, according to a study appearing in the July 12 issue of JAMA, an HIV/AIDS theme issue.
Researchers from UAB, Emory and Microsoft demonstrate that HIV has evolved to be pre-adapted to the immune response, worsening clinical outcomes in newly infected patients.
Actor Charlie Sheen's public disclosure in November 2015 that he has the human immunodeficiency virus (HIV) corresponded with the greatest number of HIV-related Google searches ever recorded in the United States, according to an article published online by JAMA Internal Medicine.
Related Hiv Reading:
HIV Essentials 2017
by Paul E. Sax (Author), Calvin J. Cohen (Author), Daniel R. Kuritzkes (Author)
The world's leading experts provide all the 'essentials' needed to manage HIV patients in the office, on the ward, and in the ICU.
Completely revised and updated, HIV Essentials 2017 incorporates the latest clinical guidelines into a step-by-step guide to the diagnosis, evaluation, management, and prevention of HIV infection and its complications. Topics include: opportunistic infections and other HIV complications, treatment of HIV and pregnancy, antiretroviral drug summaries, post-exposure prophylaxis, as well as commercially available dosage forms for all ARVs. View Details
2018 ADULT HIV/AIDS TREATMENT POCKET GUIDE (2018 edition)
by John G Bartlett (Author), Paul A Pham (Author)
This HIV/AIDS summarizes National Clinical Guidelines with an attempt to achieve brevity, clarity and accuracy in guiding clinical decisions relevant to the management of adult patients with HIV/AIDS. This guide includes expanded drug-drug interactions tables, antiretroviral pictures tables, and summary of treatment guidelines.View Details
Fundamentals of HIV Medicine: (CME edition)
by American Academy of HIV Medicine (Compiler), W. David Hardy (Compiler)
Completely updated for 2017, Fundamentals of HIV Medicine is a comprehensive clinical care publication for the treatment of HIV/AIDS. Published by the American Academy of HIV Medicine, the book offers physicians, pharmacists, nurse practitioners, and other care providers the most up-to-date overview of the latest HIV treatments and guidelines plus online access to CME. The online access expires August 2018.
Embodying the AAHIVM's commitment to promoting uniform excellence in care of seropositive patients, Fundamentals of HIV Medicine 2017 empowers health... View Details
Living a Healthy Life with HIV
by Allison Webel RN Ph.D (Author), Kate Lorig DrPH (Author), Diana Laurent MPH (Author), Virginia González MPH (Author), Allen L. Gifford MD (Author), David Sobel MD MPH (Author), Marian Minor PT PhD (Author)
Completely updated to the current care guidelines from the Centers for Disease Control and elsewhere, this book addresses the current emphasis on managing medications for HIV treatment and many of the illnesses that commonly occur along with HIV. Combining the latest medical advice with the ideas of hundreds of people living with HIV, the book is helpful for adults living with HIV, and for friends, family members, and others who support anyone struggling with HIV. New additions to this edition include topics such as aging with HIV and coping with the emotions brought about by being a... View Details
100 Questions & Answers About HIV and AIDS
by Joel E. Gallant (Author)
Whether you're a newly diagnosed patient or a friend or relative of someone suffering from HIV or AIDS, this book can help. Offering both doctor and patient perspectives, 100 Questions & Answers About HIV and AIDS, Fourth Edition provides authoritative and practical answers to the most commonly asked questions by patients and their loved ones. What is the difference between HIV and AIDS? How can HIV infection be prevented? How do I find the right medical care?
Along with the answers to these and other questions, this book provides information on diagnosis, treatment, living with HIV... View Details
HIV & AIDS: A Very Short Introduction (Very Short Introductions)
by Alan Whiteside (Author)
In 2008 it was believed that HIV/AIDS was without doubt the worst epidemic to hit humankind since the Black Death. The first case was identified in 1981; by 2004 it was estimated that about 40 million people were living with the disease, and about 20 million had died. Yet the outlook today is a little brighter. Although HIV/ AIDS continues to be a pressing public health issue the epidemic has stabilised globally, and it has become evident it is not, nor will it be, a global issue. The worst affected regions are southern and eastern Africa. Elsewhere, HIV is found in specific, usually,... View Details
The Chimp and the River: How AIDS Emerged from an African Forest
by David Quammen (Author)
In this "frightening and fascinating masterpiece" (Walter Isaacson), David Quammen explores the true origins of HIV/AIDS.
The real story of AIDS―how it originated with a virus in a chimpanzee, jumped to one human, and then infected more than 60 million people―is very different from what most of us think we know. Recent research has revealed dark surprises and yielded a radically new scenario of how AIDS began and spread. Excerpted and adapted from the book Spillover, with a new introduction by the author, Quammen's hair-raising investigation tracks the... View Details
Taking Turns: Stories from HIV/AIDS Care Unit 371 (Graphic Medicine)
by MK Czerwiec (Author)
In 1994, at the height of the AIDS epidemic in the United States, MK Czerwiec took her first nursing job, at Illinois Masonic Medical Center in Chicago, as part of the caregiving staff of HIV/AIDS Care Unit 371. Taking Turns pulls back the curtain on life in the ward.
A shining example of excellence in the treatment and care of patients, Unit 371 was a community for thousands of patients and families affected by HIV and AIDS and the people who cared for them. This graphic novel combines Czerwiec’s memories with the oral histories of patients, family members, and staff. It... View Details
100 Questions & Answers About HIV and AIDS
by Joel E. Gallant (Author)
Whether you're a newly diagnosed patient or a friend or relative of someone suffering from HIV or Aids, this book can help. Offering both doctor and patient perspectives, 100 Questions & Answers About HIV and Aids, Third Edition provides authoritative and practical answers to the most commonly asked questions by patients and their loved ones. What is the difference between HIV and Aids? How can HIV infection be prevented? How do I find the right medical care?
Along with the answers to these and other questions, this book provides information on diagnosis, treatment, living with HIV and... View Details
Living with HIV: A Patient's Guide, 2D Ed. (Mcfarland Health Topics)
by Mark Cichocki RN (Author)
In its updated and expanded second edition, this helpful guide offers a wealth of information for people living with HIV and for people caring for HIV-positive loved ones. All aspects of HIV/AIDS are discussed, including opportunistic and associated infections, dental care, exercise and nutrition, substance use and abuse and emotional treatment. New information will help the newly diagnosed adjust to their illness and long-term survivors to improve their quality of life. Up-to-date discussion of the latest medications covers the growing practice of using HIV drugs as preventatives. Essential... View Details