Antiretroviral Regimen and Pregnancy Outcomes of Women Living With Human Immunodeficiency Virus in a US Cohort

Women who are pregnant and living with human immunodeficiency virus (HIV) have traditionally been excluded from clinical trials regarding new pharmacotherapy. Immediate initiation of antiretroviral therapy is recommended for women who are pregnant and living with HIV. Integrase strand inhibitors (INSTIs) are first-line recommended agents because they lead to more rapid HIV viral load reduction. We conducted a retrospective study of women who are pregnant and living with HIV who received prenatal care at the University of Washington. Mothers were categorized by antiretroviral therapy class: INSTI, protease inhibitors, and nonnucleoside reverse transcriptase inhibitors. chi 2 and t tests were used for the analysis of baseline characteristics, and generalized estimating equations were used to adjust for HIV viral suppression between groups. There were a total of 234 mother-infant pairs whose pregnancies progressed beyond 20 weeks. The study demonstrated that women on INSTI regimens were more likely to have a shorter time to viral load suppression than women on nonnucleoside reverse transcriptase inhibitor regimens. In addition, 7 congenital anomalies were identified in this cohort, none of which were neural tube defects. There was no perinatal transmission of HIV to any of the infants. This small cohort of women provides high-quality data regarding the safety and efficacy of INSTI use for both mothers and infants in resource-rich settings.