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Dr Melissa Perry Guy’s & St Thomas’ NHS Foundation Trust London United Kingdom

Lopinavir and atazanavir in pregnancy: preterm delivery rates, infant outcomes and virological efficacy. Dr Melissa Perry Guy’s & St Thomas’ NHS Foundation Trust London United Kingdom. Low rates of mother-to-child transmission of HIV in UK & Ireland. Townsend et al CROI 2013 poster 906.

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Dr Melissa Perry Guy’s & St Thomas’ NHS Foundation Trust London United Kingdom

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  1. Lopinavir and atazanavir in pregnancy: preterm delivery rates, infant outcomes and virological efficacy. Dr Melissa Perry Guy’s & St Thomas’ NHS Foundation Trust London United Kingdom

  2. Low rates of mother-to-child transmission of HIV in UK & Ireland

  3. Townsend et al CROI 2013 poster 906

  4. What we know? • Excellent ART coverage • Excellent PMTCT Preterm delivery concerns • Drug or drug class? • Timing of ART?

  5. www.bhiva.org

  6. As per HIV treatment guidelines for non pregnant individuals - based on VL, CD4 & genotype • Conceive on ART • remain on the same ART* • Commencing ART for maternal health • start ART ASAP • All women should commence ART by 24W* • No recommended dose adjustments. • Therapeutic drug monitoring - only consider.

  7. In clinical practice: • Two most commonly used PIs in pregnancy in the UK are ritonavir-boosted lopinavirand ritonavir-boosted atazanavir Our Question? Atazanavir or lopinavirin pregnancy?

  8. Outcomes • Pre term delivery • Infant outcomes • transmission • birth weight • phototherapy requirement • birth defects • Tolerability and viral response • clinical and virological aspects

  9. Retrospective case note review • 9 London HIV specialist care centres • All pregnancies • commenced on atazanavir or lopinavir or • conceived on atazanavir or lopinavir • delivered 1st Sept 2007 - 30th Aug 2012

  10. Results • n=493 pregnancies • Median age 33 years • Ethnicity • 81% Black African. • HIV acquisition • 97% through heterosexual exposure • 0.6% from injecting drug use • Hepatitis co-infection • Hep B – 4% • Hep C – 1%

  11. AtazanavirLopinavir Total number of patients: 187 306

  12. NRTI Backbone Atazanavir Lopinavir % on standard dose 88% 92%

  13. Numbers of patients

  14. % of women who delivered <37W AtazanavirLopinavirp-value Overall: 19 (13%) 40 (14%)ns Conceived on 11 (15%) 8 (12%) 0.98 Post conception 16 (20%) 24 (12%) 0.12 *8 percent (1 in 13) of general population UK live births are born preterm

  15. Infant outcomes AtazanavirLopinavir Transmissions 1 (0.7%) 1 (0.4%) Overall MTCT rate: 0.5% % requiring phototherapy 2 (2%) 2 (1%) Birth defects 3 (3%) 2 (2%) (Conceived on) % <2500g birth weight 23 (15%) 40 (15%)

  16. Tolerability / toxicity AtazanavirLopinavir Conceived on 2 (2%) 5 (6%) Post conception 5 (5%) 24 (11%) 55% related to nausea & vomiting

  17. Viral load decay AtazanavirLopinavir Gestation 20w 22w (at starting ART) % VL<=50 cps/ml 85% 81% 0.61 at delivery Median days VL <= 50 cps/ml 56days 43days 0.52 (despite the majority of women on ATV/r receiving the standard 300/100mg dose and co-prescribed tenofovir.)

  18. Conclusions • Both regimens were successful in preventing MTCT • No significantdifference between ATV/r and LPV/r in preterm delivery rates infant outcomes tolerability and toxicity virological efficacy • The PTD rates were comparable to those reported in previous studies and more favourable than others

  19. Limitations • Retrospective case note review • Small case numbers • Lacks power • Limited scope for multivariable logistic regression analysis

  20. Summary • This is the first study comparing pregnancy outcomes between these two PIs. • This study suggests bothPI regimens at standard dosing are comparable in terms of virological efficacy, preterm delivery rates and infant outcomes.

  21. Disclosure • I have received travel grants from Abbott, Boehringer Ingelheim, ViiV, Gilead.

  22. Melissa Perry1, Katie Conway1, Caroline Sabin2, Stuart Flanaghan3, Ellen Dwyer4, Stevenson J4, Larissa Mulka5, Anna McKendry6, Elizabeth Williams8, Alison Barbour10, Sherie Roedling6, Rimi Shah7, Jane Anderson3, Mette Rodgers4, Chris Wood8, Liat Sarner9, Phillip Hay10, Graham Taylor5, Annemiek DeRuiter1. 1Guys and St Thomas NHS Foundation Trust. 2Department of Infection and Population Health, Division of Population Health, UCL Medical School. 3Homerton University Hospital NHS Foundation Trust. 4Croydon University Hospital. 5Imperial College Healthcare NHS Trust. 6Central and North West London NHS Foundation Trust. 7Barnet and Chase Farm hospital NHS trust. 8The North Middlesex University Hospital NHS Trust. 9Barts Health NHS Trust. 10St Georges Healthcare NHS Trust Authors & Affiliations

  23. Questions?

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