Pregnancy outcomes following exposure to efavirenz-based antiretroviral therapy in the Republic of Congo.
WHO recently recommended efavirenz (EFV) use for HIV infection through pregnancy, breastfeeding and childbearing age. However the use of EFV during pregnancy remains of concern and not all national guidelines reflect WHO advice. Few data are available concerning pregnancy outcomes. The objective of our study was to evaluate pregnancy outcomes in a cohort of women who conceived on EFV. A retrospective, multicenter cohort study was conducted in Pointe Noire, Republic of Congo (September 2005- June 2012). The following adverse pregnancy outcomes were considered: births defects, low birth weight, premature delivery, stillbirth and abortion, stratified by antiretroviral exposure at the time of conception. During the study period, 188 women conceived on antiretrovirals: 35 (18.6%) on EFV-based regimens and 153 (81.4%) on nevirapine-based regimens. Adverse pregnancy outcomes were observed in 17/35 (48.6%, 95% CI 33.0-64.4%) women in the EFV group and in 43/153 (28.1%, 95% CI 21.6-35.7%) in the non-EFV group (p=0.019). No birth defect was observed in either group. An increased incidence of adverse pregnancy outcomes was observed in the EFV group. As WHO is promoting a widespread use of EFV also for women in childbearing age, our study emphasizes the importance of launching large prospective cohort studies investigating pregnancy outcomes in exposed women.
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Francesca
F
Bisio
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Elena
E
Nicco
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Anna
A
Calzi
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Daniele Roberto
DR
Giacobbe
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Alessio
A
Mesini
Hôpital de base de Tie Tie, Pointe Noire, Republic of Congo.
Hubert
H
Banguissa
Hôpital Régional des Armées, Pointe Noire, Republic of Congo.
Nicole Edith
NE
Vividila
Hôpital de base de Tie Tie, Pointe Noire, Republic of Congo.
Pélagie
P
Mahoungou
Centre de Santé integré de Mouissou Madeleine Pointe Noire, Republic of Congo.
Jean Denis
JD
Boumba
Hôpital Régional des Armées, Pointe Noire, Republic of Congo.
Franc Astyanax Mayinda
FA
Mboungou
Hygiene Unit, IRCSS AOU San Martino-IST, Genoa, Italy.
Bianca
B
Bruzzone
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Sandra
S
Ratto
Hygiene Unit, IRCSS AOU San Martino-IST, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
Giancarlo
G
Icardi
Infectious Diseases Unit, University of Genoa, Genoa, Italy.
Claudio
C
Viscoli
Clinical Epidemiology, IRCCS AOU San Martin- IST, Genoa, Italy.
Paolo
P
Bruzzi
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D048588:Benzoxazines / Q000008:administration & dosage*; D003223:Congo; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D011256:Pregnancy Outcome; D012189:Retrospective Studies
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz
Africa; Birth defects; Efavirenz; Pregnancy; Pregnancy outcome