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Does Changing Antiretroviral Therapy in the First Trimester for Pregnancy-Related Concerns Have an Impact on Viral Suppression?

38 Pages Posted: 17 Jul 2018

See all articles by Violaine Peyronnet

Violaine Peyronnet

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP); University Paris Diderot, Sorbonne Paris Cité - Louis-Mourier Hospital (AP-HP)

Josiane Warszawski

Université Paris-Saclay - INSERM CESP U1018; Université Paris-Sud; University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP); Hôpital Bicêtre

Jeanne Sibiude

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP); University Paris Diderot, Sorbonne Paris Cité - Louis-Mourier Hospital (AP-HP); Université Paris VII Denis Diderot

Olivia Dialla

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP)

Agnès Bourgeois Moine

Hôpital Bichat, APHP

Eida Bui

AP-HP Hôpital Trousseau

Caroline Simon Toulza

University of Toulouse 3, Paul Sabatier University - Toulouse University Hospital

Delphine Peretti

Hôpital Bicêtre

Cécile Brunet-Cartier

CHU de Nantes

Véronique Avettand-Fenoel

Necker-Enfants Malades Hospital; Universite Paris Descartes

Jérôme Le Chenadec

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP)

Albert Faye

Université Paris VII Denis Diderot; AP-HP Hôpital R. Debré

Roland Tubiana

Sorbonne University - University Hospitals Pitié Salpêtrière - Charles Foix

Laurent Mandelbrot

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP); University Paris Diderot, Sorbonne Paris Cité - Louis-Mourier Hospital (AP-HP); Université Paris VII Denis Diderot

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Abstract

Objective: To determine whether changing antiretroviral therapy (ART) during pregnancy in order to follow guidelines because of concern about fetal risks led to poorer virological outcomes.

Methods: All pregnancies in women with HIV1 infection enrolled in the national multicenter prospective French Perinatal cohort were included between 01/2005 and 12/2015, at 14 gestational weeks or more and if the mother was on ART at conception with a plasma viral load < 50 copies/ml. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy, and defined as for pregnancy-related concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics.

Results: Of 10553 pregnancies in the cohort, 1797 were taking ART at conception and had a viral load <50 copies/mL before 14 weeks' gestation. Of these, 411 changed regimens in the first trimester for pregnancy-related concerns. The proportion of change was statistically higher when initial treatment was clearly contraindicated (OR adjusted: 23.1 [14.0- 38.2]) or was regarded as an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for pregnancy-related concerns did not lead to poorer virological control, compared to pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]).

Conclusions: Changing ART early in pregnancy with the goal of improving fetal and pregnancy outcomes did not appear to have a destabilizing effect on viral suppression.

Financial Support: This work was supported by the French Agence Nationale de Recherche sur le SIDA (ANRS).

Potential Conflicts of Interest: The authors declare no conflicts of interest in relation with this work.

Ethics Approval Statement: The French Perinatal Cohort (ANRS EPF CO1/CO11) is a prospective, obervational study ongoing since 1985 in 90 perinatal centers throughout France (8) which includes all pregnancies in women with HIV-1 and/or HIV-2 with their informed consent and ethics committee (Comité de Protection des Personnes) approval.

Keywords: HIV, pregnancy, antiretroviral therapy, preconception care, treatment switch, guidelines, viral suppression

Suggested Citation

Peyronnet, Violaine and Warszawski, Josiane and Warszawski, Josiane and Warszawski, Josiane and Sibiude, Jeanne and Dialla, Olivia and Bourgeois Moine, Agnès and Bui, Eida and Simon Toulza, Caroline and Peretti, Delphine and Brunet-Cartier, Cécile and Avettand-Fenoel, Véronique and Le Chenadec, Jérôme and Faye, Albert and Tubiana, Roland and Mandelbrot, Laurent, Does Changing Antiretroviral Therapy in the First Trimester for Pregnancy-Related Concerns Have an Impact on Viral Suppression? (July 16, 2018). Available at SSRN: https://ssrn.com/abstract=3214917 or http://dx.doi.org/10.2139/ssrn.3214917

Violaine Peyronnet

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP) ( email )

France

University Paris Diderot, Sorbonne Paris Cité - Louis-Mourier Hospital (AP-HP) ( email )

France

Josiane Warszawski

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP)

France

Université Paris-Sud

Faculté Jean-Monnet, 54, bd Desgranges
Sceaux, 92331
France

Université Paris-Saclay - INSERM CESP U1018

55 Avenue de Paris
Versailles, 78000
France

Hôpital Bicêtre

France

Jeanne Sibiude

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP)

France

University Paris Diderot, Sorbonne Paris Cité - Louis-Mourier Hospital (AP-HP)

France

Université Paris VII Denis Diderot

5 Rue Thomas Mann
Paris, 75013
France

Olivia Dialla

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP)

France

Agnès Bourgeois Moine

Hôpital Bichat, APHP

France

Eida Bui

AP-HP Hôpital Trousseau

France

Caroline Simon Toulza

University of Toulouse 3, Paul Sabatier University - Toulouse University Hospital

Toulouse
France

Delphine Peretti

Hôpital Bicêtre

France

Cécile Brunet-Cartier

CHU de Nantes

27 Rue la Pérouse
Nantes Cedex 1, 44000
France

Véronique Avettand-Fenoel

Necker-Enfants Malades Hospital

Paris, 75015
France

Universite Paris Descartes

12, rue de l'Ecole de Médecine
Cedex 06
Paris, 75270
France

Jérôme Le Chenadec

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP)

France

Albert Faye

Université Paris VII Denis Diderot

5 Rue Thomas Mann
Paris, 75013
France

AP-HP Hôpital R. Debré

France

Roland Tubiana

Sorbonne University - University Hospitals Pitié Salpêtrière - Charles Foix

175 Rue du Chevaleret
75013
France

Laurent Mandelbrot (Contact Author)

University of Angers - Joint Research Unit 1018 - Center for Research in Epidemiology and Population Health (CESP) ( email )

France

University Paris Diderot, Sorbonne Paris Cité - Louis-Mourier Hospital (AP-HP) ( email )

France

Université Paris VII Denis Diderot ( email )

5 Rue Thomas Mann
Paris, 75013
France