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article imageLinks found between HIV treatment and birth defects

By Sarah Curran Ragan     May 17, 2014 in Science
Specific links between medicines used to manage HIV in pregnant women, and the prevalence and type of birth defects, have been found in a new study.
AIDS and HIV infection are most often treated with Antiretroviral therapy (ART), a combination of individual drugs that work together to prevent viral replication and further spread. In the 1990s studies showed that ART used during pregnancy can substantially reduce mother to fetus transmission. Over the last decade ART in pregnancy has been very successful, reducing mother to child transmission of HIV from 20 percent to 1 percent.
Since 2004, standard practice in France and many other industrialised nations is to treat HIV-infected pregnant women with triple combination ART drugs. However, there is recent concern over the potential toxicity of these drugs to foetal development, specifically their risks to the development of the embryo.
Previous studies have been inconsistent and inconclusive. Such discrepancy may be due to the populations size used in the studies and the methods used to diagnose birth defects. Now a new study has used a large cohort to estimate the prevalence of birth defects in children exposed in utero to ART drugs, and to further assess specific birth defects. Pregnant mothers living with HIV face many challenges, and choosing the right treatment regime for mother and child requires support.
Analysis of the associations between ART drug use and birth defects were conducted in 13,124 children born alive between 1 January 1994 and 31st December 2010, using the French Perinatal Cohort, which enrols HIV infected women delivering in 90 centres nationally. 42% of these live births were exposed to antiretrovirals (ARV) in the first trimester of pregnancy.
The overall birth defect rate was 4.4 percent according to the European Surveillance of Congential Anomalies (EUROCAT) classification of birth defects and 7.0 percent using the Metropolitan Atlanta Congenital Defects Program (MACDP) classification system. In analysis, adjusting for other ART drugs, maternal age, geographical origin, intravenous drug use and type of maternity centre, a significant association was found between exposure to the drug, zidovudine, in the first trimester, and congenital heart defects.
The drugs didanosine and indinavir were associated with head and neck defects respectively. There were associations between the drug, efavirenz and neurological defects using the MACDP classification. However, this was not significant when using the EUROCAT system. There were no associations found between birth defects and Iopinavir or ritonavir, nevirapine, tenofovir, stavudine or abacavir.
According to the authors, the potential mechanisms underlying the association between drug use and birth defects are unclear and require further investigation. Nevertheless, the study results have provided valuable data for treatment options.
“In conclusion we found a higher rate of congenital heart defects in children exposed in utero to zidovudine, which should be taken into consideration given the large number of children exposed to perinatal zidovudine in the world.”
The absence of associations between several other ARV drugs that are increasingly prescribed is reassuring, and should be explored as alternatives to zidovudine treatment regimes.
However, the authors’ stress that whatever affects some ARV drugs may have on birth defects it is largely surpassed by the role of ARV drugs in preventing mother to child transmission from 20 percent without ART to less than 1 percent.
Association between Prenatal Exposure to Antiretroviral Therapy and Birth Defects: An Analysis of the French Perinatal Cohort Study (ANRS CO1/CO11)
Sibiude J, Mandelbrot L, Blanche S, Le Chenadec J, Boullag-Bonnet N, et al. (2014) Association between Prenatal Exposure to Antiretroviral Therapy and Birth Defects: An Analysis of the French Perinatal Cohort Study (ANRS CO1/CO11).
PLoS Med 11(4): e1001635. doi: 10.1371/journal.pmed.1001635.
More about Arv, Art, Antiretroviral drugs, HIV, Std
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