icon-    folder.gif   Conference Reports for NATAP  
  International AIDS Conference
Durban, South Africa
July 18-22 2016
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Raltegravir containing antiretroviral therapy for prevention of mother to child transmission in a high risk population of HIV-infected pregnant women in Buenos Aires, Argentina: maternal and neonatal outcomes....
  "No vertical transmission was documented to date"
Reported by Jules levin
Durban 2016 July 18-22
Diego Martin Cecchini
D.M. Cecchini1, M. Martinez2, L. Morganti1, C. Rodriguez1
1Hospital Cosme Argerich, Infectious Diseases Unit, Buenos Aires, Argentina, 2Hospital Cosme Argerich, Neonatology Unit, Buenos Aires, Argentina


Background: Mother-to-child-transmission of HIV-1 in Buenos Aires remained high (4-7%) in recent years: novel strategies for reduction are needed. There is limited information regarding the use of raltegravir (RAL) in subpopulations of HIV-infected pregnant women (HIPW) with high transmission rates (late presenters [LP] and those with detectable antepartum viral load [VL] despite antiretroviral therapy [ART]). We aimed to evaluate: 1) trends in RAL prescription in HIPW in our institution; 2) maternal/neonatal outcomes after RAL exposure.
Methods: Retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015).
Results: A total of 239 HIPW were assisted; 31 received RAL-containig ART (12.9%): 8/130 (6.15%) in period 2009-2012 vs. 23/109 in 2013-2015 (21%) (p< 0.001 OR: 4, 95%CI:1.7-9.5). Clinical scenarios: 1) intensification (INS): addition of RAL to current ART because of detectable antepartum VL, 13 (41.9%); 2) LP: standard ART + RAL as fourth drug, 15 (48.4%); 3) treatment of resistant-HIV: 3 (9.7%). The median (interquartile range) of age, baseline VL and CD4 T-cell count were: 23 years (19-32); 6840 copies/mL (2445-66650) and 300/μL (197-436), respectively. Ten (33.3%) acquired HIV perinatally (the rest, sexually). Median gestational age at RAL initiation was 34 (29-36) weeks and median exposure was 30 days. In INS-group median VL decrease was 1.48 log10 (0.98-1.77) and 70% had peripartum VL < 50. In LP-group, median VL decline was 2.15 log10 (1.40-2.85); 45.5% and 100% had peripartum VL < 50 and < 400, respectively. No clinical adverse events or maternal intolerance attributable to RAL were observed; 1 had moderate transaminases elevation. One patient had a stillbirth. Elective cesarean section was done in 51.7%; 18.5% of births were preterm. Neonatal prophylaxis: AZT in 57.1% (the rest, combined prophylaxis). Mild elevation of transaminases was observed in 35% of neonates; 14.8% required phototherapy. No vertical transmission was documented to date (all infants had a negative PCR in the first week, 70% at >2 months and 23% had negative 18-month ELISA).
Conclusions: RAL prescription in HIPW increased in the recent years in our institution, mainly in high risk populations. A rapid maternal virological response with RAL containg ART was observed, without major cautionary signals or perinatal transmission.