The management of HIV infection has completely transformed. HIV is now considered a chronic, controllable disease instead of a lethal illness. As a result, a large number of HIV-positive women are deciding to become pregnant, but these pregnancies are not free of complications. Specifically, the mother’s antiretroviral treatment may affect the fetus.
Due to the immunosuppressive effect of pregnancy, HIV-infected mothers use antiretroviral therapies to prevent opportunistic infections. Antiretroviral treatments also prevent the transmission of the virus from the mother to the child.
However, some studies show that the children of HIV-positive mothers tend to be born prematurely and with low weight. These complications seem to be related not only to antiretroviral regimens (including protease inhibitors received during pregnancy) but also to poor prenatal care, substance abuse, anemia, and sexually transmitted diseases.
The Research Study
A group of Argentine, Brazilian, and North American researchers performed a study titled “Maternal Antiretroviral Drugs during Pregnancy and Infant Low Birth Weight and Preterm Birth,” in which they analyzed data from different local health institutions in order to test the hypothesis that antiretroviral treatment during pregnancy is associated with an increased risk of low birth weight and preterm birth among infants of HIV-infected women.
The researchers obtained information from two previous studies performed in Latin American and Caribbean countries where this problem is more frequent and worrisome. The primary objective of these studies was to characterize the adverse effects of antiretroviral treatment on HIV-infected women and their children. Selection began in 2002 and is still ongoing.
Mothers were recruited from preexisting outpatient clinics for HIV-infected pregnant women. Maternal visits were conducted during pregnancy, at delivery, and three other times until six months postpartum. The infants were observed until they reached six months of age.
During visits, the researchers obtained the women’s medical histories, conducted physical examinations, and collected laboratory samples. The participants were evaluated by infectologists, obstetricians, and pediatricians with expertise in the management of HIV-infected patients at participating clinical sites.
This study shows that, among HIV-infected women in Latin America and the Caribbean, antiretroviral regimens containing protease inhibitors are not associated with an increased risk of preterm birth and low birth weight compared to other antiretroviral treatments or uninfected women.
This differs from previous studies in which the highest index of preterm births and low birth weight occurred in children of HIV-positive mothers who received this type of medication. These previous studies also showed that other antiretroviral regimens that did not include protease inhibitors had little or no impact on children’s birth weight.
However, it is important to continue monitoring women infected with HIV and their children, especially uninfected babies, for possible adverse effects associated with maternal HIV treatment or with interventions meant to prevent mother-to-child transmission of HIV.
Pregnant HIV-infected mothers should stay in regular contact with their doctors and maintain their antiretroviral treatments. Breastfeeding is not advised if a maternal HIV infection is present, so consult a pediatrician to determine the best diet for the baby.
Szyld, Edgardo G., Eduardo M. Warley, Laura Freimanis, René Gonin, Pedro E. Cahn, Guilherme A. Calvet, Geraldo Duarte, Victor H. Melo, Jennifer S. Read, and NISDI Perinatal Study Group. “Maternal Antiretroviral Drugs during Pregnancy and Infant Low Birth Weight and Preterm Birth.” Aids 20, no. 18 (2006): 2345–2353. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17117021