Multicenter review of protease inhibitors in 89 pregnancies.
BACKGROUND
Despite the success of highly active antiretroviral therapy, the optimal approach for preventing perinatal HIV-1 transmission is not known.


OBJECTIVE
A retrospective survey was conducted at six centers in the United States and Puerto Rico from January 1997 to October 1998 to evaluate the effects of protease inhibitor use during pregnancy on maternal and infant safety, prematurity rate, and frequency of perinatal HIV-1 transmission.


RESULTS
In the study, 91 live infants, including 3 sets of twins, and 1 neonate who died shortly after birth were born to 89 women. HIV perinatal transmission rate in this series was 0 (95% confidence interval [CI], 0%-3%). Prematurity rate was 19.1%, comparable to rates in earlier reports of HIV-1-infected women. In multiple regression analysis, only cocaine use and premature rupture of membranes were associated with prematurity (p =.03 and.008, respectively). The gestational week during which the protease inhibitors were initiated was not found to be significantly associated with prematurity. Adverse maternal, obstetric, and infant events possibly related to protease inhibitors were uncommon.


CONCLUSIONS
Protease inhibitors appeared generally safe in mothers and infants in this series. No perinatal HIV-1 transmission occurred. Further prospective, controlled studies are needed to define the optimal management of HIV-1 in pregnancy.
Morris
A B
AB
Community Research Initiative, Springfield, MA 01107, USA. amorrismd@pol.net
Cu-Uvin
S
S
Harwell
J I
JI
Garb
J
J
Zorrilla
C
C
Vajaranant
M
M
Dobles
A R
AR
Jones
T B
TB
Carlan
S
S
Allen
D Y
DY
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001034:Apgar Score; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000008:administration & dosage; D016014:Linear Models; D015337:Multicenter Studies as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011647:Puerto Rico; D012044:Regression Analysis; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D014481:United States; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage
D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015215:Zidovudine