Pregnant women living with HIV don't always receive antiretroviral medications recommended for use in pregnancy, according to a recent study published in Jama Network Open this week. Ann & Robert H. Lurie Children's Hospital of Chicago's researchers collaborated in the multi-site Surveillance Monitoring for ART Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS) network.
Among over 1500 pregnant women living with HIV studied, more than 30% were prescribed drugs to treat HIV that were not recommended or had insufficient evidence for use during pregnancy by national guidelines."
Ellen Chadwick, MD, senior author, infectious disease specialist at Lurie Children's and Professor of Pediatrics at Northwestern University Feinberg School of Medicine
Since 1994, the US Department of Health and Human Services Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission has published guidelines on what drugs should be used to treat pregnant women living with HIV. The guidelines are routinely amended to reflect new drugs and clinical trials.
"Every year new drugs to treat HIV are developed, but to protect the fetus, pregnant women are typically excluded from clinical trials of newer medications until they have been tested in non-pregnant adults," said Dr. Chadwick who has been working with children and adolescents with HIV for more than 30 years. "As a result, data in pregnancy are delayed and often lag behind published guidelines. Doctors may then prescribe drugs ahead of recommendations based on promising effectiveness in the general HIV population, before safety in pregnancy has been confirmed."
Powis, K.M. et al. (2019) Antiretroviral Prescribing Practices Among Pregnant Women Living With HIV in the United States, 2008-2017. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2019.17669.