Highly active ART (HAART) before or during pregnancy may increase the risk for adverse birth outcomes, such as preterm delivery and low birth weight, compared with other ART for HIV, reports Healio. “The risk of adverse birth outcomes was increased in HIV-infected pregnant women exposed to (highly active ART (HAART)),” Dr Nan Li, of the department of global health and population at the Harvard TH Chan School of Public Health, and colleagues wrote. “Although the beneficial effects of HAART on women’s own health and mother-to-child transmission are indisputable, it is important to continue monitoring adverse birth outcomes in this population.”
The researchers conducted a prospective observational study of 3,314 women with HIV at 10 sub-Saharan African centers that provided perinatal care. Three groups were identified within the cohort, including 452 women who received no ART, 1768 who received Retrovir (zidovudine, ViiV Healthcare) and 1,094 who received HAART.
Mothers who received HAART before pregnancy had an increased instance of preterm delivery vs mothers who received only zidovudine (RR = 1.24; 95% CI, 1.05-1.47). Study results also showed that mothers who received HAART during pregnancy had an increased instance of children small for gestational age, compared with mothers who received only zidovudine (RR = 1.47; 95% CI, 1.09-1.98).
The researchers said while these adverse outcomes ranged from mild to severe, the benefits of ART, such as prevention of mother-to-child transmission, outweighed the risks associated with nontreatment during pregnancy.
“Further studies are needed to elucidate the potential mechanism by which HAART may affect birth outcomes and determine optimal regimens of HAART to optimize health outcomes and minimize side effects in both mother and infant,” Li and colleagues wrote.
In an accompanying editorial, Dr Lynn M Mofenson, of the Elizabeth Glaser Paediatric AIDS Foundation, emphasised the need for more research on the effects of ART on children born to mothers with HIV. “While the benefits of ART for preventing mother-to-child transmission and maternal health clearly outweigh the risks identified to date, with global treatment scale-up, 1.5m HIV-infected pregnant women and their foetuses will annually be exposed to ART,” Mofenson wrote. “We need to recognise that we have limited data on what these risks are; further research is needed to identify how to optimise ART to allow safe, healthy pregnancies for HIV-infected women and enhance health outcomes for their uninfected infants.”
Although the beneficial effects of antiretroviral (ARV) therapy for preventing mother-to-child transmission are indisputable, studies in developed and developing countries have reported conflicting findings on the association between ARV exposure and adverse birth outcomes. We conducted a prospective observational study at 10 human immunodeficiency virus (HIV) care and treatment centers in Dar es Salaam, Tanzania. Multivariate log-binomial regression was used to investigate the associations between ARV use and adverse birth outcomes among HIV-negative HIV-exposed infants. Our findings demonstrate an increased risk of adverse birth outcomes associated with the use of highly active antiretroviral therapy during pregnancy. Further studies are needed to investigate the underlying mechanisms and identify the safest ARV regimens for use during pregnancy.