Kinetics and Determining Factors of the Virologic Response to Antiretrovirals during Pregnancy

HIV-infected pregnant women with undetectable plasma HIV RNA concentrations at delivery pose a minimal risk of vertical transmission. We studied the kinetics and the determinants of the virologic response to antiretroviral therapy in 117 consecutive pregnancies. Patients who initiated therapy during...

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Bibliographic Details
Published in:	Infectious Diseases in Obstetrics and Gynecology 2009, Vol.2009, p.621780-8
Main Authors:	Weinberg, Adriana, Harwood, Jeri E. F., McFarland, Elizabeth J., Pappas, Jennifer, Davies, Jill, Kinzie, Kay, Barr, Emily, Paul, Suzanne, Salbenblatt, Carol, Soda, Elizabeth, Vazquez, Anna, Peloquin, Charles A., Levin, Myron J.
Format:	Article
Language:	eng
Subjects:	Adult Anti-HIV Agents - administration & dosage Anti-HIV Agents - therapeutic use Antiretroviral drugs Antiretroviral Therapy, Highly Active Care and treatment Case studies CD4 Lymphocyte Count Clinical medicine Clinical Study Diagnosis Disease transmission Female Health aspects Highly active antiretroviral therapy HIV HIV - drug effects HIV - genetics HIV infection HIV Infections - drug therapy HIV Infections - transmission HIV Infections - virology Human immunodeficiency virus Humans Infectious Disease Transmission, Vertical - prevention & control Kinetics Plasma Pregnancy Pregnancy Complications, Infectious - drug therapy Pregnancy Complications, Infectious - virology Pregnancy Outcome Pregnancy, Complications of Pregnant women Prevention Risk factors RNA, Viral - blood Viral Load - drug effects Womens health
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Summary:	HIV-infected pregnant women with undetectable plasma HIV RNA concentrations at delivery pose a minimal risk of vertical transmission. We studied the kinetics and the determinants of the virologic response to antiretroviral therapy in 117 consecutive pregnancies. Patients who initiated therapy during pregnancy had a VL decrease of 2 and 2.5 log10 after 4 and 24 weeks, respectively. Therapeutic drug monitoring (TDM) of the protease inhibitors administered in doses recommended for nonpregnant adults resulted in below-target concentrations in 29%, 35%, and 44% of 1st, 2nd, and 3rd trimester measurements, respectively, but low drug concentrations did not correlate with virologic failure. Demographic characteristics, antiretroviral experience prior to pregnancy, baseline VL, or use of specific antiretrovirals did not affect the virologic response. Adherence to ≥95% of prescribed doses and utilization of psychosocial services were associated with undetectable plasma HIV RNA at delivery. In conclusion, the virologic responses of pregnant and nonpregnant adults share similar charactersitics.
ISSN:	1064-7449 1098-0997