Does Changing Antiretroviral Therapy in the First Trimester for Pregnancy-Related Concerns Have an Impact on Viral Suppression?

Objective: To determine whether changing antiretroviral therapy (ART) during pregnancy in order to follow guidelines because of concern about fetal risks led to poorer virological outcomes. Methods: All pregnancies in women with HIV1 infection enrolled in the national multicenter prospective French Perinatal cohort were included between 01/2005 and 12/2015, at 14 gestational weeks or more and if the mother was on ART at conception with a plasma viral load < 50 copies/ml. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy, and defined as for pregnancy-related concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics. Results: Of 10553 pregnancies in the cohort, 1797 were taking ART at conception and had a viral load <50 copies/mL before 14 weeks' gestation. Of these, 411 changed regimens in the first trimester for pregnancy-related concerns. The proportion of change was statistically higher when initial treatment was clearly contraindicated (OR adjusted: 23.1 [14.0- 38.2]) or was regarded as an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for pregnancy-related concerns did not lead to poorer virological control, compared to pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]). Conclusions: Changing ART early in pregnancy with the goal of improving fetal and pregnancy outcomes did not appear to have a destabilizing effect on viral suppression. Financial Support: This work was supported by the French Agence Nationale de Recherche sur le SIDA (ANRS). Potential Conflicts of Interest: The authors declare no conflicts of interest in relation with this work. Ethics Approval Statement: The French Perinatal Cohort (ANRS EPF CO1/CO11) is a prospective, obervational study ongoing since 1985 in 90 perinatal centers throughout France (8) which includes all pregnancies in women with HIV-1 and/or HIV-2 with their informed consent and ethics committee (Comite de Protection des Personnes) approval.