title: Extended antenatal use of triple antiretroviral therapy for prevention of mother-to-child transmission of HIV-1 correlates with favorable pregnancy outcomes.
abstract: OBJECTIVE
  To evaluate pregnancy outcomes in a cohort of HIV-infected women receiving triple antiretroviral therapy (ART) for prevention of mother-to-child-transmission.
  
  
  METHODS
  A retrospective cohort study with review of records of 3273 HIV-positive women receiving prenatal care in Malawi and Mozambique from July 2005 to December 2009 was conducted in Drug Resource Enhancement Against AIDS and Malnutrition (DREAM) centers. Patients were offered nevirapine-based triple ART initiated in pregnancy until 6 months postpartum. Main outcome measures were maternal mortality, abortion/stillbirth, prematurity, and low birth weight.
  
  
  RESULTS
  Maternal mortality was 1.2% (42/3273): 7.4% in 68 women with no antenatal ART and 0.7% in 1370 with at least 90 days of antenatal ART [P < 0.001; odds ratio (OR) 0.29 (95% confidence interval [CI] 0.14-0.96]. Abortion/stillbirth was 5.2% (169/3273): 26.5% in 68 women with no ART and 5.0% in 1370 women with at least 90 days of antenatal ART [P < 0.001; OR 0.39 (95% CI 0.27-0.57)]. Prematurity was 19.1%: 70% in 10 women with no antenatal ART and 8.5% in 1330 women with at least 90 days of antenatal ART [P < 0.001; OR 0.15 (95% CI 0.14-0.19)]. Low birth weight was 11.5% (57/496) and not associated with ART duration. The protective effect of antenatal ART against mortality, fetal demise, and prematurity was independent of CD4 strata. Multivariate analysis for BMI, CD4 cell count, virus load, days in care, predelivery length of ART, and hemoglobin demonstrated an independent association between predelivery length of ART and CD4 with maternal mortality, abortion/stillbirth, and prematurity. ART toxicities were infrequent (5.2%).
  
  
  CONCLUSIONS
  Antenatal triple ART reduces adverse pregnancy outcomes in HIV-infected women.
authors.affiliation: LUMSA University, Rome, Italy.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Marazzi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
authors.forename: Jere
authors.initials: J
authors.lastname: Haswell
authors.forename: Ines
authors.initials: I
authors.lastname: Zimba
authors.forename: Nurja A
authors.initials: NA
authors.lastname: Magid
authors.forename: Ersilia
authors.initials: E
authors.lastname: Buonomo
authors.forename: Paola
authors.initials: P
authors.lastname: Scarcella
authors.forename: Susanna
authors.initials: S
authors.lastname: Ceffa
authors.forename: Giovanna
authors.initials: G
authors.lastname: Paturzo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Narciso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liotta
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008428:Maternal Mortality; D009073:Mozambique; D019829:Nevirapine / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D012189:Retrospective Studies; D050497:Stillbirth; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine