Initial Multicenter Experience With DoubleNucleoside Therapy for Human ImmunodeficiencyVirus Infection During Pregnancy

[摘要] Objective:To study maternal and neonatal effects of combination nucleoside analog therapy administeredto human immunodeficiency virus (HIV)-infected pregnant women for maternal indications.Methods:A multicenter, prospective observational study was undertaken at six perinatal centersin the United States and Canada that supported regional referral programs for the treatment ofHIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collectedfor 39 women whose antiretroviral treatment regimens were expanded to include more thanone nucleoside analog for maternal indications. The 40 newborns were monitored at pediatricreferral centers through at least three months of age to ascertain their HIV infection status.Results:For all 39 women, zidovudine (ZDV) therapy was instituted at 13.4 ± 8.2 weeks, witha second agent (lamivudine [3TC] in 85% of cases) being added at a mean gestational age of 17.6weeks. Duration of therapy with two agents was 20.6±10.4 weeks overall, with no women stoppingmedications because of side effects or toxicity. No significant changes in maternal laboratory valueswere seen, except for an increase in mean corpuscular volume, over the course of pregnancy. Noclinically significant adverse neonatal outcomes were noted, with all but the three preterm newbornsleaving hospital with their mothers. Neonatal anemia (hematocrit < 50%) was seen in 62% ofnewborns, with no children needing transfusion; mild elevations of liver function tests, primarilyaspartate aminotransferase, were noted in 58% of newborns tested, though none were clinicallyjaundiced. Overall rate of neonatal HIV infection was 2.5% (95% confidence interval: 0.1–13.2%).Conclusion:Combination antiretroviral therapy during pregnancy with two nucleoside analogswas well-tolerated by mothers and newborns, with no significant short-term toxicities or side effectsnoted. Surveillance of exposed newborns’ hematologic and liver function appears warranted.

[学科分类] 妇产科学