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A case series of third-trimester raltegravir initiation: Impact on maternal HIV-1 viral load and obstetrical outcomes.

Boucoiran I, Tulloch K, Pick N, Kakkar F, van Schalkwyk J, Money D, Boucher M - Can J Infect Dis Med Microbiol (2015 May-Jun)

Bottom Line: After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission).Further assessment of RAL safety during pregnancy is warranted.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, University of British Columbia, BC Women's Hospital, Vancouver, British Columbia; ; Women's Health Research Institute, BC Women's Hospital, Vancouver, British Columbia;

ABSTRACT

Objective: To describe the impact of initiating raltegravir (RAL)-containing combination antiretroviral therapy (cART) regimens on HIV viral load (VL) in pregnant women who have high or suboptimal VL suppression late in pregnancy.

Methods: HIV-infected pregnant women who started RAL-containing cART after 28 weeks' gestation from 2007 to 2013 were identified in two university hospital centres.

Results and discussion: Eleven HIV-infected women started RAL at a median gestational age of 35.7 weeks (range 31.1 to 38.0 weeks). Indications for RAL initiation were late presentation in pregnancy (n=4) and suboptimal VL suppression secondary to poor adherence or viral resistance (n=7). Mean VL at the time of RAL initiation was 73,959 copies/mL (range <40 to 523,975 copies/mL). Patients received RAL for a median of 20 days (range one to 71 days). The mean decline in VL from the time of RAL initiation to delivery was 1.93 log, excluding one patient who received only one RAL dose and one patient with undetectable VL at the time of RAL initiation. After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission). There were no cases of perinatal HIV transmission.

Conclusion: The present study provides preliminary data to support the use of RAL-containing cART to expedite HIV-1 VL reduction in women who have a high VL or suboptimal VL suppression late in pregnancy, and to decrease the risk of HIV perinatal transmission while avoiding Caesarean section. Further assessment of RAL safety during pregnancy is warranted.

No MeSH data available.


Related in: MedlinePlus

Examples of HIV RNA viral load evolution after raltegravir (RAL) initiation late in pregnancy. Case 4: a 33-year-old woman from Haiti who had recently immigrated to Canada was first seen at the authors’ clinic at 35 weeks’ gestation. A combination of zidovudine (AZT), lamivudine (3TC), boosted lopinavir (LPV/r) and RAL was immediately started. An elective Caesarean section was performed at 38 weeks, after intravenous zidovudine. At delivery, the HIV viral load was retrospectively found to be 154 copies/mL. Case 9: a 29-year-old First Nations iparous woman coinfected with hepatitis C with a history of substance abuse was first seen at 10 weeks’ gestation. Because of tolerance and adherence issues, her viral load was 32,820 copies/mL at 34 weeks’ gestation. She was admitted to hospital for supervised combination antiretroviral drug therapy (ART) containing RAL and received a total of seven days of this regimen. An emergent Caesarean section was performed at 35 weeks’ gestation in the context of preterm labour, after an intravenous loading dose of AZT and a single-dose of oral nevirapine 200 mg. At delivery, her HIV viral load was retrospectively found to be 338 copies/mL. Both newborns were uninfected. ABC Abacavir
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f1-idmm-26-145: Examples of HIV RNA viral load evolution after raltegravir (RAL) initiation late in pregnancy. Case 4: a 33-year-old woman from Haiti who had recently immigrated to Canada was first seen at the authors’ clinic at 35 weeks’ gestation. A combination of zidovudine (AZT), lamivudine (3TC), boosted lopinavir (LPV/r) and RAL was immediately started. An elective Caesarean section was performed at 38 weeks, after intravenous zidovudine. At delivery, the HIV viral load was retrospectively found to be 154 copies/mL. Case 9: a 29-year-old First Nations iparous woman coinfected with hepatitis C with a history of substance abuse was first seen at 10 weeks’ gestation. Because of tolerance and adherence issues, her viral load was 32,820 copies/mL at 34 weeks’ gestation. She was admitted to hospital for supervised combination antiretroviral drug therapy (ART) containing RAL and received a total of seven days of this regimen. An emergent Caesarean section was performed at 35 weeks’ gestation in the context of preterm labour, after an intravenous loading dose of AZT and a single-dose of oral nevirapine 200 mg. At delivery, her HIV viral load was retrospectively found to be 338 copies/mL. Both newborns were uninfected. ABC Abacavir

Mentions: The median gestational age at delivery was 38.7 weeks; one patient (case 9) delivered at 35 weeks in a context of spontaneous preterm labor. At the time of delivery, nine women had a HIV VL <1000 copies/mL, of which seven were <50 copies/mL. Figure 1 summarizes the typical VL evolution after RAL initiation.


A case series of third-trimester raltegravir initiation: Impact on maternal HIV-1 viral load and obstetrical outcomes.

Boucoiran I, Tulloch K, Pick N, Kakkar F, van Schalkwyk J, Money D, Boucher M - Can J Infect Dis Med Microbiol (2015 May-Jun)

Examples of HIV RNA viral load evolution after raltegravir (RAL) initiation late in pregnancy. Case 4: a 33-year-old woman from Haiti who had recently immigrated to Canada was first seen at the authors’ clinic at 35 weeks’ gestation. A combination of zidovudine (AZT), lamivudine (3TC), boosted lopinavir (LPV/r) and RAL was immediately started. An elective Caesarean section was performed at 38 weeks, after intravenous zidovudine. At delivery, the HIV viral load was retrospectively found to be 154 copies/mL. Case 9: a 29-year-old First Nations iparous woman coinfected with hepatitis C with a history of substance abuse was first seen at 10 weeks’ gestation. Because of tolerance and adherence issues, her viral load was 32,820 copies/mL at 34 weeks’ gestation. She was admitted to hospital for supervised combination antiretroviral drug therapy (ART) containing RAL and received a total of seven days of this regimen. An emergent Caesarean section was performed at 35 weeks’ gestation in the context of preterm labour, after an intravenous loading dose of AZT and a single-dose of oral nevirapine 200 mg. At delivery, her HIV viral load was retrospectively found to be 338 copies/mL. Both newborns were uninfected. ABC Abacavir
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507840&req=5

f1-idmm-26-145: Examples of HIV RNA viral load evolution after raltegravir (RAL) initiation late in pregnancy. Case 4: a 33-year-old woman from Haiti who had recently immigrated to Canada was first seen at the authors’ clinic at 35 weeks’ gestation. A combination of zidovudine (AZT), lamivudine (3TC), boosted lopinavir (LPV/r) and RAL was immediately started. An elective Caesarean section was performed at 38 weeks, after intravenous zidovudine. At delivery, the HIV viral load was retrospectively found to be 154 copies/mL. Case 9: a 29-year-old First Nations iparous woman coinfected with hepatitis C with a history of substance abuse was first seen at 10 weeks’ gestation. Because of tolerance and adherence issues, her viral load was 32,820 copies/mL at 34 weeks’ gestation. She was admitted to hospital for supervised combination antiretroviral drug therapy (ART) containing RAL and received a total of seven days of this regimen. An emergent Caesarean section was performed at 35 weeks’ gestation in the context of preterm labour, after an intravenous loading dose of AZT and a single-dose of oral nevirapine 200 mg. At delivery, her HIV viral load was retrospectively found to be 338 copies/mL. Both newborns were uninfected. ABC Abacavir
Mentions: The median gestational age at delivery was 38.7 weeks; one patient (case 9) delivered at 35 weeks in a context of spontaneous preterm labor. At the time of delivery, nine women had a HIV VL <1000 copies/mL, of which seven were <50 copies/mL. Figure 1 summarizes the typical VL evolution after RAL initiation.

Bottom Line: After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission).Further assessment of RAL safety during pregnancy is warranted.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, University of British Columbia, BC Women's Hospital, Vancouver, British Columbia; ; Women's Health Research Institute, BC Women's Hospital, Vancouver, British Columbia;

ABSTRACT

Objective: To describe the impact of initiating raltegravir (RAL)-containing combination antiretroviral therapy (cART) regimens on HIV viral load (VL) in pregnant women who have high or suboptimal VL suppression late in pregnancy.

Methods: HIV-infected pregnant women who started RAL-containing cART after 28 weeks' gestation from 2007 to 2013 were identified in two university hospital centres.

Results and discussion: Eleven HIV-infected women started RAL at a median gestational age of 35.7 weeks (range 31.1 to 38.0 weeks). Indications for RAL initiation were late presentation in pregnancy (n=4) and suboptimal VL suppression secondary to poor adherence or viral resistance (n=7). Mean VL at the time of RAL initiation was 73,959 copies/mL (range <40 to 523,975 copies/mL). Patients received RAL for a median of 20 days (range one to 71 days). The mean decline in VL from the time of RAL initiation to delivery was 1.93 log, excluding one patient who received only one RAL dose and one patient with undetectable VL at the time of RAL initiation. After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission). There were no cases of perinatal HIV transmission.

Conclusion: The present study provides preliminary data to support the use of RAL-containing cART to expedite HIV-1 VL reduction in women who have a high VL or suboptimal VL suppression late in pregnancy, and to decrease the risk of HIV perinatal transmission while avoiding Caesarean section. Further assessment of RAL safety during pregnancy is warranted.

No MeSH data available.


Related in: MedlinePlus