The treatment of HIV with antiretroviral therapies (ARTs) has improved people’s quality of life and extended their life span. This also leads to more HIV-infected women having children, as ARTs also protect the baby from contracting the virus. However, ARTs may cause negative effects on pregnancy outcomes, with increases in preterm birth rates.
In the study by Elenga et al., pregnancy outcomes of HIV-positive mothers receiving different types of ART were compared to uninfected pregnant women. Data were collected between January 1, 2013 to December 31, 2015 at Cayenne Hospital in French Guiana. In these three years, 117 HIV-positive women gave birth to live singletons and were included in the study. Additionally, 470 pregnant women took part in the HIV-negative control group.
All HIV infected mothers received treatment according to the country’s protocol. The treatment lasted throughout the whole pregnancy and included highly active antiretroviral therapy with two nucleoside-reverse-transcriptase inhibitors (NRTI) and/or a boosted protease inhibitor (PI). The mothers received different types of NRTIs and PIs. The women were checked once a month by testing their blood plasma for HIV RNA. Furthermore, doctors checked the biological tolerance to ARVs once every 2 months, and the CD4 lymphocytes every 3 months. All women were in a good condition and otherwise healthy.
Overall, women infected with HIV had a higher probability of delivering their baby preterm than HIV-negative mothers, with a rate of 31.6% compared to the rate of 13.5% in uninfected women. The authors state that the preterm birth rate might be higher due to CD4 lymphocyte cell depletion in HIV-positive women. Another reason could be that the infection may alter the cytokine profile in the placenta and thus restrict foetal development. It may also be caused by maternal or foetal stress and inflammation, among other factors.
Moreover, some forms of ART presented higher risks for preterm birth than others. Therapies with PIs were associated with a higher rate of preterm deliveries. The PIs used in this study were always ritonavir-boosted. The authors mentioned that ritonavir is known to cause complex metabolic changes, and therefore the adrenal systems of mother on child may have been affected, resulting in spontaneous labour. However, further research is needed to verify these theories, especially as boosted PI therapy is very common.
One of the study’s limitations is that the number of mothers not receiving PI was rather small. Additionally, other PIs apart from the ritonavir-boosted PI were not used in this study. Therefore, it remains unknown if other PI types have different impacts on preterm birth. Overall, the sample size was too small to reach generalisable results. Nevertheless, the new insights are an important impulse for further research.
Article available at: Medicine®
Full list of authors: Narcisse Elenga, Félix Djossou, Mathieu Nacher