A Multicenter Analysis of Elvitegravir Use During Pregnancy on HIV Viral Suppression and Perinatal Outcomes.

• Authors: Martina Louise Badell, Emory University; Anandi Sheth, Emory University; Florence Momplaisir, Drexel University School of Medicine; Lisa Rahangdale, University of North Carolina, Chapel Hill; JoNell Potter, University of Miami; Padmashree C Woodham, Mercer University; Gweneth B. Lazenby, Medical University of South Carolina, Charleston; William R. Short, University of Pennsylvania; Scott E. Gillespie, Emory University; Nevert Baldreldin, Northwestern University; Emily S. Miller, Northwestern University; Gregg Alleyne, Drexel University School of Medicine; Lunthita M. Duthely, University of Miami Miller School of Medicine; Stephanie M. Allen, Drexel University School of Medicine, Philadelphia; Judy Levison, Baylor College of Medicine; Rana Chakraborty, Emory University
• Journal Title: Open Forum Infectious Diseases
• Volume: Volume 6, Number 4
• Publisher: Oxford University Press (OUP) | 2019-04, Pages ofz129-ofz129
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/ofid/ofz129
• Subjects: Health Sciences, Obstetrics and Gynecology
• Keywords: HIV viral suppression; obstetrics and gynecology; perinatal outcomes; prevention of mother-to-child transmission

Abstract

Background: There is a knowledge gap on the clinical use of elvitegravir (EVG) during pregnancy and maternal viral suppression. Our objective was to evaluate the effects of EVG use in pregnancy on rates of HIV virologic suppression and perinatal outcomes. Methods: We conducted a retrospective, multicenter study of pregnant women living with HIV (WLHIV) who used EVG-containing antiretroviral therapy (ART) between January 2014 and March 2017 at 9 tertiary care centers in the United States. WLHIV were included if they took EVG at any time during pregnancy. We described the characteristics of the WLHIV using EVG during the study period and evaluated the rates of HIV suppression and perinatal outcomes. Results: Among 134 pregnant WLHIV who received EVG at any time during pregnancy, viral suppression at delivery (HIV-1 RNA < 40 copies/mL) occurred in 81.3%. In WLHIV who initiated EVG before pregnancy and continued through delivery (n = 68), the rate of viral suppression at delivery was 88.2%. The average gestational age at the time of delivery was 37 weeks 6 days, and the overall rate of preterm birth was 20%. No cases of open neural tube defects were noted in women on EVG at the time of conception (n = 82). The perinatal HIV transmission rate was 0.8%. Conclusions: EVG use was associated with high sustained levels of HIV suppression during pregnancy and a low rate of perinatal HIV transmission.