title: Treatment switches during pregnancy among HIV-positive women on antiretroviral therapy at conception.
abstract: OBJECTIVE
  To describe antiretroviral therapy (ART) use and clinical status, at start of and during pregnancy, for HIV-positive women receiving ART at conception, including the proportion conceiving on drugs (efavirenz and didanosine) not recommended for use in early pregnancy.
  
  
  METHODS
  Women with a pregnancy resulting in a live-birth after 1995 (n = 1537) were identified in an observational cohort of patients receiving HIV care at 12 clinics in the UK by matching records with national pregnancy data. Treatment and clinical data were analysed for 375 women conceiving on ART, including logistic regression to identify factors associated with changing regimen during pregnancy.
  
  
  RESULTS
  Of the 375 women on ART, 39 (10%) conceived on dual therapy, 306 (82%) on triple therapy and 30 (8%) on more than three drugs. In total, 116 (31%) women conceived on a regimen containing efavirenz or didanosine (69 efavirenz, 54 didanosine, seven both). Overall, 38% (143) changed regimen during pregnancy, of whom 44% (n = 51) had a detectable viral load around that time. Detectable viral load was associated with increased risk of regimen change [adjusted odds ratio 2.97, 95% confidence interval (CI) (1.70-5.19)], while women on efavirenz at conception were three times more likely to switch than women on other drugs [3.40, (1.84-6.25)]. Regimen switching was also associated with year at conception [0.89, (0.83-0.96)].
  
  
  CONCLUSIONS
  These findings reinforce the need for careful consideration of ART use among women planning or likely to have a pregnancy in order to reduce viral load before pregnancy and avoid drugs not recommended for early antenatal use.
authors.affiliation: UCL Medical School, Royal Free Campus, UK. susan.huntington.09@ucl.ac.uk
authors.forename: Susie E
authors.initials: SE
authors.lastname: Huntington
authors.forename: Loveleen K
authors.initials: LK
authors.lastname: Bansi
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.forename: Teresa
authors.initials: T
authors.lastname: Hill
authors.forename: Pat A
authors.initials: PA
authors.lastname: Tookey
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
mesh_terms: D000293:Adolescent; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D048588:Benzoxazines / Q000008:administration & dosage*; D003521:Cyclopropanes; D016049:Didanosine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005306:Fertilization; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D012307:Risk Factors; D006113:United Kingdom; D019562:Viral Load; D055815:Young Adult
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz; D016049:Didanosine