Few studies have compared the clinical efficacy and adverse events of combined antiretroviral therapy (cART) regimens in pregnant women seeking obstetrical care. The objective of this study was to compare the efficacy (virus load response), adverse events, and obstetrical and neonatal outcomes of three different regimens of cART in HIV-infected pregnant women initiating treatment in Rio de Janeiro, Brazil. This was a retrospective cohort study of cART-naive pregnant women who initiated either ritonavir-boosted protease inhibitors (atazanavir or lopinavir), efavirenz, or raltegravir plus a backbone regimen. From 2014 to 2018, 390 pregnant women were followed over time. At baseline, the median viral load (VL) for HIV was 4.1 log copies/ml. Among participants who received cART for 2 to 7 weeks, the VL decline was greater for raltegravir (2.24 log copies/ml) than for efavirenz or protease inhibitors (P < 0.001). Virologic suppression was achieved in 87% of women on raltegravir near delivery versus 73% on efavirenz and 70% on protease inhibitors (P = 0.011). Patients on raltegravir achieved virologic suppression faster than those on other regimens (P = 0.019). Overall, the HIV perinatal infection rate was 1.5%. This clinical study compared three potent and well-tolerated cART regimens and demonstrated that a higher proportion of participants on raltegravir achieved an undetectable HIV VL near delivery (P = 0.011) compared to the other arms. These findings suggest that raltegravir-containing regimens are optimal regimens for women with HIV initiating treatment late in pregnancy.

中文翻译：

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孕期启动的三种抗逆转录病毒疗法的疗效：里约热内卢的临床经验

很少有研究比较联合抗逆转录病毒疗法 (cART) 方案对寻求产科护理的孕妇的临床疗效和不良事件。本研究的目的是比较三种不同 cART 方案对巴西里约热内卢开始治疗的 HIV 感染孕妇的疗效（病毒载量反应）、不良事件以及产科和新生儿结局。这是一项针对未接受过 cART 的孕妇的回顾性队列研究，这些孕妇启动了利托那韦增强的蛋白酶抑制剂（阿扎那韦或洛匹那韦）、依非韦伦或拉替拉韦加主干方案。从 2014 年到 2018 年，对 390 名孕妇进行了长期随访。在基线时，HIV 的中位病毒载量 (VL) 为 4.1 log copies/ml。在接受 cART 治疗 2 至 7 周的参与者中，raltegravir 的 VL 下降幅度更大 (2.P < 0.001）。临近分娩时，87% 接受拉替拉韦的女性实现了病毒学抑制，而接受依非韦伦的这一比例为 73%，接受蛋白酶抑制剂的女性为 70%（P = 0.011）。接受 raltegravir 治疗的患者比接受其他治疗方案的患者更快地实现病毒学抑制 ( P = 0.019)。总体而言，围产期 HIV 感染率为 1.5%。这项临床研究比较了三种有效且耐受性良好的 cART 方案，并证明与其他组相比，使用 raltegravir 的参与者中有更高比例的人在临近分娩时达到检测不到的 HIV VL ( P = 0.011)。这些发现表明，包含拉替拉韦的方案是妊娠晚期开始治疗的 HIV 感染女性的最佳方案。