Pregnancy Outcomes Among HIV-Infected Women Undergoing Antiretroviral Therapy

BACKGROUND The use of antiretroviral drugs (ARV) to prevent mother-to-child HIV transmission (PMTCT) promises to be effective. However, limited data on the adverse effects of ARV among pregnant women and pregnancy outcomes have been reported in clinical practice. OBJECTIVES This study aimed to assess adverse effects and outcomes among pregnant HIV-infected women receiving antiretroviral drugs for either antiretroviral therapy (ART) or PMTCT. STUDY DESIGN This cohort study was at Chonburi Hospital, Thailand, in 2002-2006. RESULTS A total of 246 pregnant HIV-infected women with the median age (range) of 27 (16-41) years were included in this study. ART was initiated in 16.3% for treatment during ANC, 66.7% for PMTCT during ANC, and 17.1% for PMTCT in labor. Adverse effects, especially anemia, were significantly associated with continuing combined ART in pregnancy (p<0.001). 88.9% delivered normal-term neonates. The prevalence of pre-term delivery was 10.2%. Overall, 24 adverse events from 21 pregnant women (8.5%) were noted. A significantly higher prevalence of pre-term delivery was noted in the groups continuing combined ART, or initiating of PMTCT during labor rather than ANC (p=0.02). The incidence of low Apgar scores was 3.6%, and these were associated with initiation of PMTCT during labor (p=0.004). CONCLUSION Adverse ARV events were more numerous among the pregnant women who needed ART than PMTCT. ANC is beneficial and strongly recommended for all pregnant HIV-infected women for better pregnancy outcomes.