Editor’s Note: HIV can be transmitted through bodily fluids such as blood, breast milk, semen, and vaginal secretions. Pregnant women who are infected with HIV should receive antiretroviral therapy (ART) as soon as possible to protect their own health and reduce the risk of transmitting HIV to their unborn child. At the recent 19th European AIDS Conference (EACS 2023), Professor Chen Yaokai and his team from the Chongqing Public Health Medical Treatment Center presented a report titled “The Effectiveness of Raltegravir in Virological Suppression of HIV-Positive Pregnant Women at Delivery: A Systematic Review and Meta-Analysis.” The study analyzed the effectiveness of Raltegravir treatment for pregnant women with HIV, initiated at different stages of pregnancy, in achieving virological suppression at the time of delivery, and conducted subgroup analyses for treated and untreated pregnant women.
Effectiveness of Raltegravir in Virological Suppression of HIV-Positive Pregnant Women at Delivery: A Systematic Review and Meta-Analysis (Abstract ID: eP.B4.004)
Research Objective
To systematically review the effectiveness of Raltegravir (RAL) in achieving virological suppression in HIV-positive pregnant women at the time of delivery.
Research Methods
Relevant studies were searched in PubMed, EMBASE, Cochrane Library, and Web of Science databases, up to January 17, 2023. Clinical trials and observational studies (cohort studies, case series, case reports) were included. The overall effectiveness of virological suppression at delivery was assessed. The primary outcome was virological suppression at delivery, defined as maternal plasma HIV RNA <200 copies/mL for those who initiated RAL treatment before late pregnancy (<28 weeks) and <1,000 copies/mL for those who initiated RAL treatment in late pregnancy (≥28 weeks). The secondary outcome was virological suppression at delivery (HIV RNA <1,000 copies/mL) for patients who initiated RAL treatment in mid-pregnancy (≥14 weeks). Subgroup analysis was conducted for the primary outcome, stratified by prior treatment status.
Research Findings
A total of 720 HIV-positive pregnant women from 22 studies were included.
Primary Outcome: The virological suppression rate at delivery was 85% (95% CI: 79%–90%).
Secondary Outcome: Among patients who initiated RAL treatment in mid-pregnancy, the virological suppression rate at delivery (HIV RNA viral load <1,000 copies/mL) was 78% (95% CI: 72%–84%).
Most of the pregnant women included in the study initiated antiretroviral therapy in late pregnancy, resulting in varying durations of RAL exposure ranging from 7 to 71 days.
Primary Outcome Subgroup Analysis: The overall effectiveness of RAL treatment for pregnant women who had not received prior antiretroviral therapy (n=29) and those who had been treated before (n=38) was 75% (95% CI: 58%–87%) and 76% (95% CI: 60%–86%), respectively.
Research Conclusion
RAL-based ART regimens are effective in achieving virological suppression in HIV-positive pregnant women, particularly those diagnosed late in pregnancy. This approach is likely to contribute to the prevention of mother-to-child transmission.
References:
Zhang Y, et al. Efficacy of Raltegravir for virological suppression at delivery in HIV positive pregnant women: A systematic review and meta-analysis. EACS 2023; abstract eP.B4.004.
Professor Chen Yaokai
Director of the Department of Infectious Diseases, Chongqing Public Health Medical Treatment Center/Southwest University Affiliated Public Health Hospital.
TAG: EACS 2023, Voice of China, HIV/AIDS, Raltegravir, Treatment,
Pregnant Women
