NEW YORK (Reuters Health) – Compared with dual therapy for HIV, highly active antiretroviral therapy (HAART) in pregnant women is associated with an increased risk of preterm delivery, according to an analysis of pooled data from three observational studies.

However, the association is not so clearcut when HAART is compared to monotherapy, Dr. Claire L. Townsend and colleagues report in BJOG published online August 17.

Dr. Townsend, at University College London, UK and colleagues explain that while HAART prescribed to HIV women has reduced the risk of perinatal HIV to about 1% in developed countries, there has been concern that HAART has adverse effects on pregnancy outcomes.

However, the evidence is conflicting, and to look into the reasons for this the researchers analyzed data from the Pediatric Spectrum of HIV Disease project (PSD) in the USA, the European Collaborative Study (ECS) on HIV-infected pregnant women and their infants, and the National Study of HIV in Pregnancy and Childhood (NSHPC) in the UK and Ireland.

While the studies covered a similar period, there were considerable differences in maternal characteristics and use of antiviral therapy. “Compared with monotherapy, HAART was associated with increased preterm delivery risk in the ECS (adjusted odds ratio [AOR] 2.40) and NSHPC (AOR 1.43), but not in the PSD (AOR 0.92),” the team found.

Data were not pooled for that comparison because the results were so divergent. However, heterogeneity disappeared when HAART was compared with dual therapy and the results could be pooled. “HAART was associated with 1.5-fold increased odds of preterm delivery compared with dual therapy (p=0.001), after adjusting for covariates,” Dr. Townsend and colleagues report.

They conclude, “Despite the concern about adverse effects of HAART, the important benefits for both maternal health and prevention of mother-to-child transmission should not be overlooked.”

Reference:

Antiretroviral therapy and preterm delivery—a pooled analysis of data from the United States and Europe


BJOG 2010