title: Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates.
abstract: OBJECTIVE
  The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r).
  
  
  METHODS
  A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared.
  
  
  RESULTS
  A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%).
  
  
  CONCLUSIONS
  Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: M E O
authors.initials: ME
authors.lastname: Perry
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: G P
authors.initials: GP
authors.lastname: Taylor
authors.affiliation: Research Department of Infection and Population Health, University College London, London, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Conway
authors.affiliation: Homerton University Hospital NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Flanagan
authors.affiliation: Croydon University Hospital NHS Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Dwyer
authors.affiliation: Croydon University Hospital NHS Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Stevenson
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Mulka
authors.affiliation: The North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: McKendry
authors.affiliation: Barts Health NHS Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Williams
authors.affiliation: St George's NHS Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Barbour
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Dermont
authors.affiliation: (Mortimer Market Centre) Central and North West London NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Roedling
authors.affiliation: Barnet and Chase Farm Hospital NHS Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.affiliation: Homerton University Hospital NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Croydon University Hospital NHS Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rodgers
authors.affiliation: The North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Wood
authors.affiliation: Barts Health NHS Trust, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Sarner
authors.affiliation: St George's NHS Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Hay
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hawkins
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: deRuiter
mesh_terms: D000293:Adolescent; D000328:Adult; D000069446:Atazanavir Sulfate / Q000008:administration & dosage* / Q000494:pharmacology; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D061466:Lopinavir / Q000008:administration & dosage* / Q000494:pharmacology; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D019438:Ritonavir / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
chemical_list: D004338:Drug Combinations; D017320:HIV Protease Inhibitors; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D019438:Ritonavir
keywords: HIV; antiretroviral therapy; atazanavir; lopinavir; pregnancy; preterm delivery; protease inhibitor