Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

Medientyp: E-Artikel
Titel: Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?
Beteiligte: Frange, Pierre; Tubiana, Roland; Sibiude, Jeanne; Canestri, Ana; Arvieux, Cédric; Brunet-Cartier, Cécile; Cotte, Laurent; Reynes, Jacques; Mandelbrot, Laurent; Warszawski, Josiane; Le Chenadec, Jérôme; Mandelbrot, Laurent; Crenn-Hebert, Catherine; Floch-Tudal, Corinne; Mazy, Fabienne; Joras, Marine; Meier, Françoise; Mortier, Emmanuel; Briquet, Catherine; Ichou, Houria; Marty, Laurence; Jabbarian, Hélène; Ceccaldi, Pierre-François; Villemant, Agnès; [...]
Erschienen: Oxford University Press (OUP), 2020
Erschienen in: Journal of Antimicrobial Chemotherapy
Sprache: Englisch
DOI: 10.1093/jac/dkaa017
ISSN: 0305-7453; 1460-2091
Entstehung:
Anmerkungen:
Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Safety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (&lt;50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was &lt;50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes.</jats:p></jats:sec>
Zugangsstatus: Freier Zugang

Nur in Feld suchen:

Zuletzt gesuchte Begriffe: