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MATERNAL TOLERABILITY OF ANTIRETROVIRAL THERAPY IN PREVENTING VERTICAL TRANSMISSION OF HIV-1
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Reported by Jules Levin
ART in pregnancy is an important part of the armamentarium in reducing vertical transmission (VT) of HIV-1. Maternal tolerability will guide prescribing practise.
Maternal tolerability of ART was analysed in a cohort of HIV-infected women prescribed ART in pregnancy (July 2000-March 2003). Adverse events were NIH/DAIDS graded.
123 women received ART in the study period. 106(86%) commenced ART in pregnancy, median duration =70 days (3-207). 17(14%) were on triple ART at conception. Number of drugs: 3xART=101, 2xART=10 and 1xART=12. 116 received zidovudine (300mg BD), 87 received nevirapine. Other drugs: co-trimoxazole, N=9 (7.3%); methadone N=12 (9.7%).
Rash: Grade 2, N=3; Grade 4, N=1. Median baseline Haemoglobin=11.1g/dL (8.1-15.6g/dl).
Haemoglobin changes did not differ significantly with duration of therapy, number of ART drugs or if therapy was started preconception versus in pregnancy.
Development of liver abnormalities was associated with nevirapine exposure (38% versus 0%, p=0.003) and baseline CD4<300 x 106/L (40% versus 25%, p=0.008). 7 (6%) developed grade 3 or 4 liver abnormalities, including 1 maternal death (fulminant hepatitis). All grade 3 and 4 liver events occurred when ART was commenced in pregnancy. Median baseline CD4 was significantly higher in those developing grade 3 and 4 liver events versus those developing grade 1 and 2 liver events, 506x106/L and 257x106/L respectively (p=0.02).
Editorial note: In other studies NVP hepatoxicity has been associated with higher CD4 cell counts.
The authors concluded that ART is generally well tolerated in pregnancy and does not significantly increase anaemia. Liver abnormalities are more common with nevirapine exposure and CD4 count <300 x 106/L. Serious liver toxicity occurred with a higher median baseline CD4.
Reference: 9TH EUROPEAN AIDS CONFERENCE (EACS), 1st EACS RESISTANCE & PHARMACOLOGY WORKSHOP, October 25 - 29, 2003 Warsaw, Poland. Oral Abstract F3/4 - MATERNAL TOLERABILITY OF ANTIRETROVIRAL THERAPY (ART) IN PREVENTING VERTICAL TRANSMISSION (VT) OF HIV-1. Lyons F., Hopkins S., Bergin C., Mulcahy F. Department of Genitourinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
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