Elvitegravir use during pregnancy for the treatment of HIV was associated with high, sustained levels of viral suppression and a low rate of perinatal transmission, according to findings from a retrospective, multicenter study.
Writing in Open Forum Infectious Diseases, Martina L. Badell, MD, director of the Emory University Hospital Midtown Perinatal Center, and colleagues highlighted that there are limited data on the use of the integrase strand transfer inhibitor (INSTI) elvitegravir (EVG) during pregnancy. Recent safety alerts linking the use of the INSTI dolutegravir during pregnancy to serious birth defects extremely limit “the number of once-daily, fixed-dose combination pills available to this population,” the researchers noted.
“EVG is a commonly prescribed [integrase strand transfer inhibitor] that requires boosting by cobicistat in combination with emtricitabine and tenofovir disoproxil fumarate or with emtricitabine/tenofovir alafenamide, providing a convenient single-tablet regimen option,” they wrote. “Our multicenter study presents important and timely data on maternal/neonatal outcomes and virologic suppression in pregnant [women living with HIV] receiving EVG-containing ART during pregnancy.”
In their analysis, the researchers included 134 pregnant women living with HIV from nine tertiary care centers in the United States who used EVG-containing ART between January 2014 and March 2017. The women were predominantly black (82.7%), most were multiparous (77.6%), and 14.2% had a history of preterm delivery. The average age of the women at delivery was 28.6 years.
According to the study, 81.3% of the women were virally suppressed at delivery — defined as less than 40 copies/mL of HIV-1 RNA. There were 68 women in the cohort who initiated EVG before their pregnancy and continued through delivery. Among those, 88.2% were virally suppressed at delivery.
The average gestational age at the time of delivery was 37 weeks and 6 days, and the overall rate of preterm birth was 20%, which the researchers said was higher than the national rate. However, they noted that other studies have “identified a possible association” between ART and preterm delivery.
The researchers did not observe any cases of open neural tube defects in women who were on EVG at the time of conception, and the perinatal HIV transmission rate was 0.8%.
“EVG use in pregnancy was associated with high, sustained and expected levels of HIV virologic suppression, and a low rate of perinatal HIV transmission,” Badell and colleagues wrote. “While further investigation is necessary, our findings offer support for the overall efficacy and safety of use of EVG-containing ART in pregnancy.”
By Marley Ghizzone