Infants exposed to an antiretroviral regimen of tenofovir, emtricitabine and efavirenz (Atripla) from conception experienced fewer adverse birth outcomes compared to other three-drug regimens, according to a study of births in Botswana between 2014 and 2016, presented by Rebecca Zash, Beth Israel Deaconess Medical Centre, Boston, at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.
The Tsepamo study, an observational analysis of approximately 45% of all births in Botswana from August 2014 to August 2016, provides important information on the safety of various regimens in common use in sub-Saharan Africa, Asia and Eastern Europe, where the vast majority of HIV-exposed infants are found.
Infants exposed to 3-drug antiretroviral therapy (ART) from conception have increased risk of adverse birth outcomes, but it is not known whether risk differs by ART regimen. We evaluated adverse birth outcomes by exposure to different ART regimens from conception.
We extracted obstetric records at 8 government hospitals in Botswana. Since 2012, Botswana guidelines have recommended TDF/FTC/EFV for adults with CD4
From August 2014 to August 2016, 47180 infants were born at surveillance maternities, representing ~45% of all births in Botswana. Information was available for 47083 (99.8%): 34615 (74%) infants were HIV-unexposed, 11932 (25%) were HIV-exposed, and 479 (1%) unknown. Among HIV-exposed infants, 6178 (52%) were continuously ART-exposed from the time of conception, 4557 (38%) were ART-exposed starting in pregnancy, 1059 (9%) had no antiretroviral exposure, and 138 (1%) had unknown timing or exposure. Combined adverse birth outcomes were more common among all HIV-exposed infants than HIV-unexposed infants (34% vs. 24%, p
Specific ART regimens used in pregnancy may impact adverse birth outcomes. Among infants exposed to ART from conception, TDF/FTC/EFV was associated with the fewest adverse birth outcomes.
Rebecca Zash, Denise Jacobson, Modiegi Diseko, Gloria Mayondi, Mompati Mmalane, Chipo Petlo, Max Essex, Shahin Lockman, Joseph Makhema, Roger L Shapiro