Brief Report: Impact of Antiretroviral Regimen on Pregnancy and Infant Outcomes in Women With HIV/ HBV Coinfection.

Abstract

BACKGROUND:

There are limited data on the impact of antenatal antiretroviral regimens (ARV) on pregnancy and infant outcomes in HIV/HBV coinfection. We compared outcomes among 3 antenatal antiretroviral regimens for pregnant women with HIV/HBV.

METHODS:

The PROMISE study enrolled ARV-naive pregnant women with HIV. Women with HBV were randomized to (no anti-HBV)-zidovudine (ZDV) + intrapartum nevirapine and 1 week of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC); (3TC)-3TC + ZDV + LPV/r; or (FTC-TDF)-FTC + TDF + LPV/r. Pairwise group comparisons were performed with Fisher exact, t , or log rank tests. Adverse pregnancy outcome (APO) was a composite of low birth weight, preterm delivery, spontaneous abortion, stillbirth, or congenital anomaly.

RESULTS:

Of 138 women with HIV/HBV, 42, 48, and 48 were analyzed in the no anti-HBV, 3TC, and FTC-TDF arms. Median age was 27 years. APOs trended lower in the no anti-HBV (26%) vs 3TC (38%), and FTC-TDF arms (35%), P ≥ 0.25). More infant deaths occurred among the FTC-TDF [6 (13%)] vs no anti-HBV [2 (5%)] and 3TC [3 (7%)] arms. There were no differences in time-to-death, HIV-free survival, birth or one-year WHO Z-score length-for-age, and head circumference. Hepatitis B e antigen (HBeAg) was associated with an increased risk of APO, 48% vs 27% (odds ratio 2.79, 95% confidence interval: 1.19 to 6.67, post hoc ).

CONCLUSION:

With HBV/HIV coinfection, the risk of an APO was increased with maternal ARV compared with ZDV alone, although the differences were not statistically significant. Maternal HBeAg was associated with a significantly increased risk of APO. Infant mortality was highest with FTC + TDF + LPV/r. Early assessment of HBeAg could assist in identifying high-risk pregnancies for close monitoring.

• Authors: Flavia Matovu Kiweewa, Camlin Tierney, Kevin Butler, Marion G Peters, Tichaona Vhembo, Dhayendre Moodley, Vani Govender, Neaka Mohtashemi, Hannah Ship, Philippa Musoke, Dingase Dula, Kathy George, Nahida Chakhtoura, Mary G Fowler, Judith S Currier, Debika Bhattacharya
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 91 Issue 1 Pg. 79-84 (09 01 2022) ISSN: 1944-7884 [Electronic] United States
• PMID: 35621877 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Anti-HIV Agents
• Anti-Retroviral Agents
• Hepatitis B e Antigens
• Lamivudine
• Zidovudine
• Tenofovir
• Emtricitabine

Topics

• Adult
• Anti-HIV Agents (therapeutic use)
• Anti-Retroviral Agents (therapeutic use)
• Coinfection (complications, drug therapy)
• Emtricitabine (therapeutic use)
• Female
• HIV Infections (complications, drug therapy)
• Hepatitis B e Antigens (therapeutic use)
• Humans
• Infant, Newborn
• Lamivudine (therapeutic use)
• Pregnancy
• Pregnancy Outcome
• Tenofovir (therapeutic use)
• Zidovudine (therapeutic use)