title: Previous antiretroviral therapy for prevention of mother-to-child transmission of HIV does not hamper the initial response to PI-based multitherapy during subsequent pregnancy.
abstract: BACKGROUND
  Few data are available on the possible long-term negative effects of a short exposure to antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT).
  
  
  OBJECTIVE
  To determine whether ART for PMTCT, discontinued after delivery, affects the virological response to highly active antiretroviral therapy (HAART) administered during subsequent pregnancies.
  
  
  METHODS
  All current pregnancies of HIV-1-infected women enrolled in the French Perinatal Cohort (ANRS CO-01 EPF) between 2005 and 2009 and not receiving ART at the time of conception were eligible. We studied the association between history of exposure to ART during a previous pregnancy and detectable viral load (VL) under multitherapy at current delivery (VL ≥ 50 copies/mL).
  
  
  RESULTS
  Among 1116 eligible women, 869 were ART naive and 247 had received PMTCT during a previous pregnancy. Previous ART was protease inhibitor (PI)-based HAART in 48%, non-PI-based HAART in 4%, nucleoside reverse transcriptase inhibitor bitherapy in 19% and zidovudine monotherapy in 29% of the women. At current pregnancy, women with or without prior exposure to ART had similar CD4 cell counts and VL before ART initiation. PI-based HAART was initiated in 90% of the women. VL was undetectable (<50 copies/mL) at delivery in 65% of previously ART-naive women, 72% of women previously exposed to HAART, 62% previously exposed to bitherapy, and 67% previously exposed to monotherapy for prophylaxis (P = 0.42). Detectable VL was not associated with previous exposure in multivariate analysis (adjusted OR for previous versus no previous exposure to ART: 0.92; 0.95% confidence interval: 0.59 to 1.44).
  
  
  CONCLUSIONS
  Efficacy of PI-based combinations is not decreased in women previously exposed to various regimens of antiretroviral PMTCT.
authors: CESP INSERM U1018, Equipe VIH et IST Le Kremlin-Bicêtre, France. nelly.briand@inserm.fr
authors: Nelly
authors: N
authors: Briand
authors: Laurent
authors: L
authors: Mandelbrot
authors: Stéphane
authors: S
authors: Blanche
authors: Roland
authors: R
authors: Tubiana
authors: Albert
authors: A
authors: Faye
authors: Catherine
authors: C
authors: Dollfus
authors: Jérôme
authors: J
authors: Le Chenadec
authors: Valérie
authors: V
authors: Benhammou
authors: Christine
authors: C
authors: Rouzioux
authors: Josiane
authors: J
authors: Warszawski
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011480:Protease Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D011480:Protease Inhibitors