Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data

Luiz Euribel Prestes-Carneiro1–21Immunology Department, University of Oeste Paulista, Presidente Prudente, São Paulo, Brazil; 2Infectious Diseases Department, Hospital Ipiranga, São Paulo, SP, BrazilAbstract: An increasing number of HIV-infected women of childbearing...

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Autor principal:	Prestes-Carneiro LE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/6f062789450e48789b34339803e899ba
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spelling	oai:doaj.org-article:6f062789450e48789b34339803e899ba2021-12-02T04:15:52ZAntiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data1179-1373https://doaj.org/article/6f062789450e48789b34339803e899ba2013-08-01T00:00:00Zhttp://www.dovepress.com/antiretroviral-therapy-pregnancy-and-birth-defects-a-discussion-on-the-a13867https://doaj.org/toc/1179-1373Luiz Euribel Prestes-Carneiro1–21Immunology Department, University of Oeste Paulista, Presidente Prudente, São Paulo, Brazil; 2Infectious Diseases Department, Hospital Ipiranga, São Paulo, SP, BrazilAbstract: An increasing number of HIV-infected women of childbearing age are initiating antiretroviral therapy (ART) worldwide. This review aims to discuss updated data of the eligible ART regimens and their role in inducing birth defects in utero. Zidovudine and lamivudine plus a non-nucleoside reverse-transcriptase inhibitor or protease inhibitor (PI) is the first-line regimen applied. The role of zidovudine exposition monotherapy or associated with other ART in inducing birth defects remains inconclusive. The main organ systems involved are genitourinary and cardiovascular. For HIV-infected pregnant women, World Health Organization (WHO) guidelines up to 2010 recommend the same group of drugs that are prescribed to nonpregnant women. The exception is efavirenz, which has been associated with an increase in the risk of teratogenicity. Increased rates of birth defects were found in large cohorts and computational studies conducted recently in infants exposed to efavirenz-containing regimens. The combination of zidovudine and lamivudine and lopinavir/ritonavir is one of the most used ART regimens for prevention of mother-to-child-transmission. Conflicting data about the role of PI exposure in utero and birth defects have been reported. However, a reduced number of studies evaluating the role of PI in inducing birth defects in women are available. An association between prematurity and PI exposure in pregnancy was extensively described. Some questions arise due to the tendency of initiating ART early in the life of HIV-infected individuals or those at risk of infection. Long-time exposure to different ART regimens and the potential effect of birth-defect induction in pregnancy are not completely understood. Developing regions harbor the highest numbers of women of reproductive age exposed to ART. Most of the largest and expressive data come from developed countries, and could not be sufficiently representative of pregnant women living in developing countries.Keywords: antiretroviral therapy, pregnancy, birth defectsPrestes-Carneiro LEDove Medical PressarticleImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol 2013, Iss default, Pp 181-189 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607
spellingShingle	Immunologic diseases. Allergy RC581-607 Prestes-Carneiro LE Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
description	Luiz Euribel Prestes-Carneiro1–21Immunology Department, University of Oeste Paulista, Presidente Prudente, São Paulo, Brazil; 2Infectious Diseases Department, Hospital Ipiranga, São Paulo, SP, BrazilAbstract: An increasing number of HIV-infected women of childbearing age are initiating antiretroviral therapy (ART) worldwide. This review aims to discuss updated data of the eligible ART regimens and their role in inducing birth defects in utero. Zidovudine and lamivudine plus a non-nucleoside reverse-transcriptase inhibitor or protease inhibitor (PI) is the first-line regimen applied. The role of zidovudine exposition monotherapy or associated with other ART in inducing birth defects remains inconclusive. The main organ systems involved are genitourinary and cardiovascular. For HIV-infected pregnant women, World Health Organization (WHO) guidelines up to 2010 recommend the same group of drugs that are prescribed to nonpregnant women. The exception is efavirenz, which has been associated with an increase in the risk of teratogenicity. Increased rates of birth defects were found in large cohorts and computational studies conducted recently in infants exposed to efavirenz-containing regimens. The combination of zidovudine and lamivudine and lopinavir/ritonavir is one of the most used ART regimens for prevention of mother-to-child-transmission. Conflicting data about the role of PI exposure in utero and birth defects have been reported. However, a reduced number of studies evaluating the role of PI in inducing birth defects in women are available. An association between prematurity and PI exposure in pregnancy was extensively described. Some questions arise due to the tendency of initiating ART early in the life of HIV-infected individuals or those at risk of infection. Long-time exposure to different ART regimens and the potential effect of birth-defect induction in pregnancy are not completely understood. Developing regions harbor the highest numbers of women of reproductive age exposed to ART. Most of the largest and expressive data come from developed countries, and could not be sufficiently representative of pregnant women living in developing countries.Keywords: antiretroviral therapy, pregnancy, birth defects
format	article
author	Prestes-Carneiro LE
author_facet	Prestes-Carneiro LE
author_sort	Prestes-Carneiro LE
title	Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
title_short	Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
title_full	Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
title_fullStr	Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
title_full_unstemmed	Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
title_sort	antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/6f062789450e48789b34339803e899ba
work_keys_str_mv	AT prestescarneirole antiretroviraltherapypregnancyandbirthdefectsadiscussionontheupdateddata
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Antiretroviral therapy, pregnancy, and birth defects: a discussion on the updated data

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