June 19, 2009

Preterm Delivery, Low Birth Weight Unlikely with Perinatal HIV Treatment

HIV treatment does not increase the risk of preterm delivery, according to a French research analysis involving more than 8,000 HIV-negative babies born to HIV-positive women over a 16-year period. The new data, published June 19 in AIDS, dispel other reports suggesting that antiretroviral (ARV) therapy, notably protease inhibitors, affects fetal development and results in low birth weight.

Ever since short-term Retrovir (zidovudine) was proved to significantly reduce the risk of an HIV-infected mother passing on the virus to her child, there have been concerns about whether this ARV treatment could negatively affect the baby. Some studies have suggested that HIV drug regimens used during pregnancy, notably those including protease inhibitors, might increase the risk of premature births or babies born with lower-than-normal birth weight. Other studies, however, did not reach the same conclusions.

Nelly Briant, MD, from the Kremlin Bicêtre Hospital in Paris and her colleagues theorized the studies that did find an increased risk of preterm delivery were flawed in their design, failing to take into account certain risk factors known to be associated with preterm births, such as babies actually born with HIV infection, twins and infants born to mothers who injected drugs. In turn, her team conducted an additional analysis involving all live births to HIV-positive women participating in the French ANRS Perinatal Cohort between 1996 and 2000, after excluding babies born with HIV infection, twins and infants born to mothers who injected drugs.  

It turned out that babies born to women who used ARV therapy were no more likely to be delivered preterm or underweight compared with those born to women who did not use HIV treatment during pregnancy. The HIV-positive women were, however, about twice as likely to deliver low birth weight babies compared with women in the general population in France.

The authors acknowledge that their data may be difficult to generalize, as they did not collect information on alcohol use, smoking and economic status before 2005. Since all of these factors are associated with preterm deliveries and low birth weight, and were not factored into the analysis, it is not possible to say how they may have influenced the results of the study.

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