Experience with Integrase Inhibitors in HIV-Infected Pregnant Women in the Madrid Cohort: A Paired Cohort Study
Author(s): Marta Illan, Diana Mazariegos, Luis Manuel Prieto, Eloy Munoz, Jose Beceiro, Luis Escosa, Sara Guillen, Ma Luisa Navarro, Ma Del Carmen Vinuela, Iciar Olabarrieta, Francisco Javier Regidor, Miguel Angel Roa, Laura Francisco, Manuel Fuentes, Arantxa Berzosa, Jose Tomas Ramos
Background: Minimizing the time to achieve complete suppression of HIV replication, is critical in pregnancy to decrease the risk of mother-to-child transmission (MTCT). Integrase inhibitors(INSTIs) are characterized by a rapid drop in viral load (VL) and a good transplacental penetration. Our objective was to determine the effectiveness of INSTIs in MTCT and present the experience in the Madrid Cohort of HIV infected mothers-infant pairs.
Methods: Paired cohorts, multicentric and observational study, that includes retrospectively the cohort of pregnant women exposed to INSTIs during pregnancy and their infants (Cohort A) from 2000 to 2017, and another cohort of mothers without INSTIs treatment and their children matched by year of birth +/- one year (Cohort B). Maternal demographic, clinical and analytical characteristics were recorded. The follow-up of children was included.
Results: 67 pregnant women exposed to INSTIs from Madrid cohort (n:1423) and their children were identified. Another group of 67 pregnant women without INSTI treatment were selected. Both groups were similar in maternal age, ethnicity and route of transmission. The percentage of pregnant women with detectable VL at the first trimester was statistically higher (p<0.01) in cohort A (46.7%) than in B (6.7%). There were no statistically significant differences in the percentage of low birthweight and preterm newborn. There were no cases of MTCT, nor differences in congenital birth defects.
Conclusions: Regimens that include INSTIs in pregnancy are increasingly being used. They seem to have comparable safety and effectiveness to other families, and appear useful in MTCT prevention even in high-risk situations.