July 24th, 2015
By Alex Morrisson
VANCOUVER — July 24, 2015 — Pregnant women who are infected with HIV can avoid mother-to-child transmission by receiving treatment with the integrase inhibitor raltegravir, according to a retrospective study presented here at the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015).
“Raltegravir…has great promise for newborns,” said Fatima Kakkar, MD, MPH, CHU Sainte-Justine on July 21. “The drug’s toxicity is minimal, and for the prevention of mother-to-child transmission, the plan is to treat early. Even if the child turns out to be infected, the child is already on an effective treatment regimen.”
Among 18 mothers in the mother-child cohort from the Centre Maternel et Infantil sur le SIDA, CHU Sainte-Justine, who were treated with raltegravir, no mother-to-child transmission occurred, and none of the children developed any serious congenital abnormalities.
In addition, newborns of 2 women infected with HIV who refused treatment during pregnancy but were treated with raltegravir after their birth were also HIV negative, said Dr. Kakkar.
Raltegravir was used for neonatal prophylaxis as part of a triple-drug regimen in these newborns at high risk of HIV infection in the cohort through the Merck Special Access, Health Canada Compassionate use protocol. All of the infants were born to women during the period 2010 to 2015.
Both of the women who refused antiretroviral therapy in pregnancy were themselves perinatally infected.
“It is very typical to refuse treatment in pregnancy among our kids who were infected perinatally and have grown up,” Dr. Kakkar said. “These patients are exceptionally difficult. They have had 20 years of antiretrovirals, and they have difficulty with adherence and often have multidrug-resistant virus.”
Of the 18 women on raltegravir in the study, 5 were taking the drug before pregnancy, and 13 were on raltegravir during pregnancy. The women treated with raltegravir during pregnancy were placed on the drug because resistance to other medication had developed, high viral loads were observed during the third trimester of pregnancy, or the women were late to start antiretroviral therapy.
At delivery, the maternal viral load was undetectable in 14 women, detectable at low levels in 3 women, and detectable at a high level in 1 woman.
Compared with other antiretroviral drugs given to pregnant women, treatment with raltegravir resulted in outcomes similar to those found in children treated with lopinavir/ritonavir and with atazanavir, including gestational age, Apgar score, birthweight, birth length, and head circumference. Biochemistry laboratory outcomes were also similar for the newborns, except that there was a significant increase in bilirubin among the atazanavir-treated patients, a known complication for that agent.
After 6 months, the growth parameters (weight, length and head circumference) were almost identical for the children regardless of the antiretroviral regimen they were taking.
“New strategies are needed for the management of these high-risk situations,” Dr. Kakkar concluded.
[Presentation title: Raltegravir for Prevention of Mother-to-Child Transmission of HIV. Abstract TUAB0105]
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