Pregnant women on ARVs needn’t fear for their babies —Experts

Today, with appropriate care, women with HIV have good chances of being able to deliver healthy babies. In 2013, the World Health Organisation (WHO) recommended all pregnant and breastfeeding women with HIV infection initiate antiretroviral drug to improve the health of the mother and survival of her baby.

Although there are overwhelming benefits of antiretroviral (ART) drug for both mother and infant, these do not come without potential risks. Despite nearly two decades of ART use in pregnancy, evidence regarding safety remains limited and conflicting.

However, in France, experts say that they had discerned no pattern of adverse pregnancy outcomes after mothers took common antiretroviral combinations.

The analysis included 924 pregnancies reported in 34 studies. The most used combinations were based on protease inhibitors (PIs) (49 per cent), NNRTIs (42 per cent), integrase inhibitors (5 per cent), and nucleosides/nucleotides (2 per cent).

This finding reported at the International Workshop on Clinical Pharmacology of HIV, Hepatitis, and Other Antiviral Drugs Virtual Meeting in September said that more than half of these women, 57 per cent, had started antiretroviral before conception, 9 per cent started in the first trimester, 21 per cent in the second or third trimester and 13 per cent did not take antiretroviral.

Most drugs, including ARVs, receive approval without specific testing in or labelling for use during pregnancy and, as a consequence, dosing and safety guidelines are often based on only anecdotal data. This poses difficult problems for pregnant women with life-threatening diseases that require treatment with drugs of unknown safety or that have known safety concerns.

But Dr Anslem Audu, health specialist, UNICEF, Port Harcourt stated that the benefits of ARV drug outweigh whatever side effects the drug is going to have for a pregnant mother.

“ARVs is very important, it plays a very major role in the prevention of mother to child HIV transmission because the ARV will reduce the mother’s viral load to an undetectable level. That will ensure that there is no transmission of HIV to the unborn child during pregnancy, during labour and delivery as well as breastfeeding.”

Dr Audu said that women need not worry about the possibility of an adverse pregnancy outcome because the ARVs prescribed in Nigeria are compatible with pregnancy.

“Pregnancy is not a contraindication to the use of ARVs. There are so many ARV combinations that we can use; many of them are compatible with pregnancy, but there are some that we try not to give during pregnancy even as we try to move the country towards the elimination of mother to child transmission of HIV.”

Dr Olubunmi Ayinde, Oyo state’s AIDS programme coordinator, stated that different ARVs have evolved over the years

Although the initial ones developed were not to be used in the first trimester, she said that over time, research has shown that there are ARV drugs that can be used throughout pregnancy and without any adverse outcome.

Dr Ayinde, however, declared that there is a possibility of an adverse drug reaction from ARV drugs in a person with HIV just like every other drug and already all hospitals had been told to make a report on any adverse reaction from any drug, including ARVs.

She added, “for now, presently there has been no report on adverse drug reactions from ARVs in Oyo State. We are presently doing training on adverse drug reactions so that these could be picked up on time. It may be there but people are not sensitive enough to pick them.”

In the study, these researchers at Toulouse had analysed data submitted to the ANRS pharmacovigilance system from 2004 to 2019. This systematic review included all HIV cohorts and trials in which pregnant women or women who might become pregnant took antiretroviral. All women were older than 18. They had wanted to get a countrywide sense of potential adverse effects of current antiretroviral during pregnancy.

Adverse pregnancy outcomes include such things as abortion, ectopic pregnancy, stillbirth, prematurity (birth before 37 weeks gestation), low birth weight (below 2500 grams), and congenital abnormalities.  A favourable pregnancy outcome is a live birth without congenital abnormalities, prematurity or low birth weight.

The researchers counted 624 live births for a live birth rate of 77.2 per cent. Among all pregnancies, 75.8 per cent were live births with no adverse pregnancy outcomes, 14.4 per cent had low birth weight, 13.1 per cent were premature, and 1.4 per cent had congenital abnormalities.

Among 184 non-live births (23.4 per cent), 9.9 per cent were spontaneous abortions, 8.7 per cent induced abortions, 3.2 per cent stillbirths, and 1.1 per cent ectopic pregnancies.

The researchers saw no differences in pregnancy outcomes between NNRTI regimens (the comparative reference) and nucleoside-only regimens, PI-based regimens, integrase inhibitor-based regimens, or other regimens for spontaneous abortions or prematurity.

Previous, a study had assessed the magnitude of the adverse effects of ARV drugs on pregnancy outcome in 290 women at the University of Port Harcourt Teaching Hospital between January 2010 and December 2013. Of these, 198 (68.28%) women commenced antiretroviral treatment before pregnancy, while 11 (3.79 per cent) started in the second trimester of pregnancy.

It reported that 90.7 per cent had live babies and 84.8 per cent of their babies were born full-term. There were only 9.3 per cent stillbirths and 9.3 per cent low birth weights respectively, and also 15.2 per cent preterm births. The 2017 study in The Nigerian Health Journal involved Bliss Mark Moore and, Charles Ibiene Tobin-West.

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