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Inicio Medicina Clínica (English Edition) Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women ...
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Vol. 155. Issue 10.
Pages 441-444 (November 2020)
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Vol. 155. Issue 10.
Pages 441-444 (November 2020)
Brief report
Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort
Efectividad y seguridad de inhibidores de integrasa en la gestante con infección VIH en la Cohorte de embarazadas de la Comunidad de Madrid
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Marta Illán Ramosa,
Corresponding author
marta.illan@salud.madrid.org

Corresponding author.
, Diana Mazariegos Orellanaa, Luis M. Prieto Tatob, M. Luisa Navarro Gómezc, Eloy Muñoz Gálligod, José Tomás Ramos Amadora
a Servicio de Pediatría, Hospital Clínico San Carlos, Madrid, Spain
b Servicio de Pediatría, Hospital 12 de Octubre, Madrid, Spain
c Servicio de Pediatría, Hospital Gregorio Marañón, Madrid, Spain
d Servicio de Ginecología, Hospital 12 de Octubre, Madrid, Spain
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Tables (3)
Table 1. Characteristics of pregnant women exposed to INIs.
Table 2. Characteristics of HAART in pregnant women.
Table 3. New-born characteristics.
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Abstract
Introduction

The risk of HIV-1 mother-to-child transmission (MTCT) is associated mainly with gestational age at which antiretroviral therapy begins and the HIV-1 RNA plasma viral load at delivery. Regimens with integrase inhibitors (INI) are increasing in high-risk pregnant women. The objective was to review the experience with INI in a Madrid Cohort of mother-infant pairs.

Patients and methods

Retrospective, multicentric, observational study, of HIV-infected pregnant women exposed to INI. Patients of 9 hospitals were included (2000–2017).

Results

Sixty-seven pregnant women exposed to INI (cohort: 1423) and 68 children (17.6% premature babies, 34.3% with combined postexposure prophylaxis). There were no cases of MTCT. Of 24 women with no previous antiretroviral therapy, 20 were diagnosed in current pregnancy. Of 43 women with antiretroviral therapy before pregnancy, 65% received INI before conception. Raltegravir was the most used (80.5%). There was a statistically significant increase (p=0.02) of mothers with undetectable viral load at delivery. INI were well tolerated. In 11.7% of exposed children minor congenital anomalies were detected.

Conclusions

INI seem safe and effective in the prevention of MTCT. Our findings support their use as intensification regimens in pregnant women with high risk of MTCT.

Keywords:
HIV infection
Mother to child transmission
Integrase inhibitor
Safety
Resumen
Introducción

El riesgo de transmisión vertical (TV) del VIH depende fundamentalmente de la edad gestacional de inicio del tratamiento antirretroviral y la carga viral materna al parto. Son crecientes las pautas con inhibidores de integrasa (INI) en embarazadas con situaciones de riesgo. Nuestro objetivo fue revisar la experiencia con INI en la Cohorte de Madrid de madres-niños.

Pacientes y métodos

Estudio retrospectivo, multicéntrico, observacional, de gestantes con infección por VIH-1 expuestas a INI de 9 hospitales públicos durante 2000-2017.

Resultados

Hubo 67 gestantes (cohorte: 1.423) y 68 neonatos (el 17,6% prematuros, el 34,3% con profilaxis combinada). No hubo casos de TV. Veinte mujeres se diagnosticaron en la gestación actual. De 43 con tratamiento antirretroviral previo a gestación, el 65% recibía INI preconcepcional. El más empleado fue raltegravir (80,5%). Aumentó significativamente (p=0,02) la proporción de madres con carga viral indetectable al parto. La tolerancia a INI fue adecuada. Hubo anomalías congénitas menores en el 11,7% de los niños.

Conclusiones

Los INI parecen seguros y eficaces como prevención de TV. Nuestros hallazgos refuerzan su utilidad como intensificación en gestantes que llegan al tercer trimestre con pauta no supresora.

Palabras clave:
Infección por VIH
Transmisión madre a hijo
Inhibidor de la integrasa
Seguridad

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