The relationship of pregnancy to the use of highly active antiretroviral therapy

OBJECTIVE: Public health agencies have recommended that the criteria for th e use of highly active antiretroviral therapy should not be modified becaus e of pregnancy. However, little information has been published with regard to the degree to which these recommendations are being followed. We report here the frequency of highly active antiretroviral therapy use among pregna nt women in the Women's Interagency HIV Study and compare the frequencies o f its use by pregnant women meeting published criteria for implementing hig hly active antiretroviral therapy and its use by nonpregnant women meeting the same criteria. STUDY DESIGN: From October 1994 through November 1995, a total of 2059 huma n immunodeficiency virus type 1-seropositive women were enrolled in a cohor t study. Participants were evaluated at baseline and at 6-month intervals w ith standardized interview instruments. In addition to a general physical e xamination at each visit, patients had a urine pregnancy test performed and were asked about current pregnancies, pregnancies since the last visit. an d which antiretroviral medications they had used since the last visit. High ly active antiretroviral therapy was defined according to 1997 National ins titutes of Health guidelines. RESULT: At each calendar interval after October 1996, a greater proportion of nonpregnant women than pregnant women reported the use of highly active antiretroviral therapy. The use of monotherapy declined for both groups dur ing the course of multiple calendar periods (P <.01), although the use of m onotherapy remained higher among the pregnant women. In any given calendar period, pregnant women meeting published criteria for highly active antiret roviral therapy use were slightly less likely than similar nonpregnant wome n to receive highly active antiretroviral therapy (odds ratio, 0.28-0.98). Because of the sample size these differences reached significance in only o ne calendar period (P=.02). With time pregnant women did demonstrate an inc rease in the percentage receiving highly active antiretroviral therapy In n early all calendar periods a larger percentage of pregnant than nonpregnant women were receiving a regimen that included zidovudine. CONCLUSIONS: Highly active antiretroviral therapy is being received by an i ncreasing percentage of women who meet published criteria for its use, and pregnancy is a relatively small impediment to its use. Further efforts are needed to bolster the use of highly active antiretroviral therapy by all ap propriate candidates and to ensure equal access to this therapy for pregnan t women. Because of the increasingly frequent use of highly active antiretr oviral therapy during pregnancy, ongoing efforts are needed to monitor any long-term effects of in utero exposure to multiple antiretroviral agents.