title: Pregnancy outcomes in women with HIV type-1 receiving a lopinavir/ritonavir-containing regimen.
abstract: BACKGROUND
  The pregnancy-related adverse effects of antiretroviral therapy (ART) have yielded discordant results, which could be explained in part by the heterogeneity of ART protocols. The objective of our study was to explore whether lopinavir/ritonavir (LPV/r) exposure during pregnancy is associated with adverse outcomes.
  
  
  METHODS
  Data on 100 consecutive HIV type-1 (HIV-1)-infected women receiving LPV/r during pregnancy and who delivered after 15 weeks gestational age (GA) between January 2003 and June 2007 in a single centre were analysed. For each HIV-1-infected woman, two uninfected women matched by age, parity and geographical origin were selected among patients delivering during the same period. Preterm delivery (PTD), vasculoplacental complications, gestational glucose intolerance and post-partum complication rates were compared between cases and controls. Factors associated with PTD and post-partum complications were assessed in HIV-1-infected women by a logistic regression model.
  
  
  RESULTS
  Rates of vasculoplacental complication and gestational glucose intolerance were not higher among HIV-1-infected women than in controls. PTD was higher in HIV-1-infected women (21%) than in controls (10%; P<0.01). In HIV-1-infected women, PTD was associated with HIV-1 RNA level > or =50 copies/ml at delivery (adjusted odds ratio 6.15, 95% confidence interval 1.83-20.63; P=0.003). No association was found between occurrence of PTD and LPV/r exposure before 14 weeks GA.
  
  
  CONCLUSIONS
  In this population of HIV-1-infected pregnant women receiving LPV/r, the risk of PTD was higher than in HIV-1-uninfected controls. As PTD risk was not associated with early exposure to LPV/r, these data support current guidelines to initiate ART earlier in pregnancy.
authors.affiliation: Université Paris Descartes, Faculté de Médecine, Paris, France. elie.azria@bch.aphp.fr
authors.forename: Elie
authors.initials: E
authors.lastname: Azria
authors.forename: Constance
authors.initials: C
authors.lastname: Moutafoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitz
authors.forename: Jean Patrick
authors.initials: JP
authors.lastname: Le Meaux
authors.forename: Anne
authors.initials: A
authors.lastname: Krivine
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Pannier
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Firtion
authors.forename: Alexandra
authors.initials: A
authors.lastname: Compagnucci
authors.forename: Laurent
authors.initials: L
authors.lastname: Finkielsztejn
authors.forename: Olivier
authors.initials: O
authors.lastname: Taulera
authors.forename: Vassilis
authors.initials: V
authors.lastname: Tsatsaris
authors.forename: Dominique
authors.initials: D
authors.lastname: Cabrol
authors.forename: Odile
authors.initials: O
authors.lastname: Launay
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D061466:Lopinavir; D007752:Obstetric Labor, Premature / Q000139:chemically induced / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D011256:Pregnancy Outcome; D011744:Pyrimidinones / Q000009:adverse effects* / Q000627:therapeutic use; D019438:Ritonavir / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D061466:Lopinavir; D019438:Ritonavir