title: Antenatal atazanavir: a retrospective analysis of pregnancies exposed to atazanavir.
abstract: BACKGROUND
  There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy.
  
  
  METHODS
  A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010.
  
  
  RESULTS
  There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), "preconception" atazanavir exposure; 27 started atazanavir-based cART as "first-line" during the pregnancy; and 29 "switched" to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman.
  
  
  CONCLUSIONS
  These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Samuel
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bradshaw
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Perry
authors.affiliation: St George's Healthcare Trust, Blackshaw Road, London SW17 0QT, UK.
authors.forename: Sum Yee
authors.initials: SY
authors.lastname: Chan
authors.affiliation: Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK.
authors.forename: Rageshri
authors.initials: R
authors.lastname: Dhairyawan
authors.affiliation: Newham University Hospital NHS Trust, Glen Road, London E13 8SL, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Byrne
authors.affiliation: Barts and the London NHS Trust, West Smithfield, London EC1A 7BE, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Smith
authors.affiliation: Croydon University Hospital NHS Trust, London Road, Surrey CR7 7YE, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Charlotte Eve
authors.initials: CE
authors.lastname: Short
authors.affiliation: King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Naftalin
authors.affiliation: North West London Hospitals NHS Trust, Acton Lane, London NW10 7NS, UK.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Offodile
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: Sundhiya
authors.initials: S
authors.lastname: Mandalia
authors.affiliation: Mortimer Market Centre, Central and North West London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK.
authors.forename: Sherie
authors.initials: S
authors.lastname: Roedling
authors.affiliation: Barnet and Chase Farm Hospitals NHS Trust, Wellhouse Lane, Barnet EN5 3DJ, UK.
authors.forename: Rimi
authors.initials: R
authors.lastname: Shah
authors.affiliation: North West London Hospitals NHS Trust, Acton Lane, London NW10 7NS, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Brook
authors.affiliation: King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Poulton
authors.affiliation: Croydon University Hospital NHS Trust, London Road, Surrey CR7 7YE, UK.
authors.forename: Mette
authors.initials: M
authors.lastname: Rodgers
authors.affiliation: Barts and the London NHS Trust, West Smithfield, London EC1A 7BE, UK.
authors.forename: Liat
authors.initials: L
authors.lastname: Sarner
authors.affiliation: Newham University Hospital NHS Trust, Glen Road, London E13 8SL, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Noble
authors.affiliation: St George's Healthcare Trust, Blackshaw Road, London SW17 0QT, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Hay
authors.affiliation: Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: Macky
authors.initials: M
authors.lastname: Natha
authors.affiliation: Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hawkins
authors.affiliation: Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Taylor
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: Annemiek
authors.initials: A
authors.lastname: de Ruiter
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000069446:Atazanavir Sulfate; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008131:London / Q000453:epidemiology; D009842:Oligopeptides / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011725:Pyridines / Q000627:therapeutic use*; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate