Mother-to-child transmission of HIV and risk of prematurity according to the time of art initiation.

Abstract

Antiretroviral therapy (ART) is recommended once the HIV infection is diagnosed during pregnancy. However, some antiretroviral regimens have been associated with an increased risk of preterm birth. This retrospective study aimed to assess the rates of prematurity in newborns according to the timing of ART initiation in a cohort of 1,062 mother-infant pairs. Early ART initiation was not associated with an increased risk of prematurity (ART initiation before conception: 16.8%; before 14 weeks of gestation: 15.6%; ART initiation between 14 and 27 weeks: 16.3%; ART initiation after 27 weeks: 21%; and no ART: 30.7%). Furthermore, exposure to INSTIs for more than 12 weeks during pregnancy was not associated with an increased risk of preterm birth (adjusted OR 1.65, 95% CI 0.46-5.95; p = 0.444). These results support current recommendations for early ART initiation during pregnancy.

Conclusion: In conclusion, these results support current recommendations for early ART initiation during pregnancy.

What is known: • Mother-to-child HIV transmission rates approach zero in women receiving ART before pregnancy and maintaining viral suppression. • Infants born to women living with HIV have been reported to have higher rates of prematurity, although the contribution of ART exposure and timing remains uncertain.

What is new: • Early ART initiation was not associated with an increased risk of prematurity and rates were lowest among women who started ART before conception. • Prolonged exposure to INSTI-based ART was not associated with an increased risk of preterm birth, supporting their current recommendations for treatment during pregnancy.