Important note: Information in this article was accurate in December 2000. The state of the art may have changed since the publication date.
Researchers in the U.S. decided to conduct a survey of 21 medical centres to find out about the impact of anti-HIV therapy on pregnancy. Only six of the centres responded to the survey, providing data on 89 HIV positive women who gave birth to 92 infants.
A profile of these women before they became pregnant was as follows:
After they sought advice about their pregnancy, about 90% of women in the survey received combination anti-HIV therapy that included a protease inhibitor.
As many as 52% of the women developed infections and complications not related to anti-HIV therapy. According to the researchers, these problems were due, in part, to pre-existing medical conditions.
A small proportion of infants (6%) had low birth weights. As with the large European study reported earlier, the weight of the majority of infants was not different among mothers who used different PIs. One infant was born very prematurely and died. The remaining 91 infants lived and were not born with HIV infection.
The three most common complications experienced by infants were seen in the following proportions:
Note that none of the women whose babies developed jaundice were taking indinavir (Crixivan). There were at least three cases of birth defects, such as Down's syndrome and cleft palate, but the researchers were unable to link these to the use of anti-HIV medications.
Overall, about 19% of babies in this survey were born prematurely. According to the researchers, 15 of the 17 women who gave birth prematurely had risk factors for this complication, such as using cocaine while pregnant. Viral load and CD4+ count were not linked to giving birth prematurely.
This study has several limitations. One major issue faced by the researchers is that only six of 21 centres responded to the survey, possibly biasing the results. Further research is necessary to compare the impact of combination therapy with and without PIs as well as the timing of such therapy in pregnant HIV positive women.
1. Morris AB, Cu-Uvin S, Harwell JI, et al. Multicentre review of protease inhibitors in 89 pregnancies. Journal of Acquired Immune Deficiency Syndromes2000;25(4):306-311.
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