Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

Abstract Background Safety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) du...

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Veröffentlicht in:Journal of antimicrobial chemotherapy 2020-05, Vol.75 (5), p.1324-1331
Hauptverfasser: Frange, Pierre, Tubiana, Roland, Sibiude, Jeanne, Canestri, Ana, Arvieux, Cédric, Brunet-Cartier, Cécile, Cotte, Laurent, Reynes, Jacques, Mandelbrot, Laurent, Warszawski, Josiane, Le Chenadec, Jérôme
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container_end_page 1331
container_issue 5
container_start_page 1324
container_title Journal of antimicrobial chemotherapy
container_volume 75
creator Frange, Pierre
Tubiana, Roland
Sibiude, Jeanne
Canestri, Ana
Arvieux, Cédric
Brunet-Cartier, Cécile
Cotte, Laurent
Reynes, Jacques
Mandelbrot, Laurent
Warszawski, Josiane
Le Chenadec, Jérôme
description Abstract Background Safety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy. Objectives To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC. Methods In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (
doi_str_mv 10.1093/jac/dkaa017
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Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy. Objectives To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC. Methods In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (&lt;50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC. Results Among 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was &lt;50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred. Conclusions In virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkaa017</identifier><identifier>PMID: 32157283</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Human health and pathology ; Life Sciences</subject><ispartof>Journal of antimicrobial chemotherapy, 2020-05, Vol.75 (5), p.1324-1331</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c354t-7aebcb40a56f2e7425e89bb86f19997c9c3ed99ac519e6de53707b15a4f69ba63</citedby><cites>FETCH-LOGICAL-c354t-7aebcb40a56f2e7425e89bb86f19997c9c3ed99ac519e6de53707b15a4f69ba63</cites><orcidid>0000-0002-4920-8369 ; 0000-0003-2332-2507 ; 0000-0003-0685-0578 ; 0000-0002-6150-2376 ; 0000-0002-8218-8814 ; 0000-0002-0242-4566 ; 0000-0003-3242-7247 ; 0000-0003-1780-8746 ; 0000-0002-7022-2990 ; 0000-0002-6817-8951 ; 0000-0001-7057-768X ; 0000-0002-5883-7597</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32157283$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-02548822$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Frange, Pierre</creatorcontrib><creatorcontrib>Tubiana, Roland</creatorcontrib><creatorcontrib>Sibiude, Jeanne</creatorcontrib><creatorcontrib>Canestri, Ana</creatorcontrib><creatorcontrib>Arvieux, Cédric</creatorcontrib><creatorcontrib>Brunet-Cartier, Cécile</creatorcontrib><creatorcontrib>Cotte, Laurent</creatorcontrib><creatorcontrib>Reynes, Jacques</creatorcontrib><creatorcontrib>Mandelbrot, Laurent</creatorcontrib><creatorcontrib>Warszawski, Josiane</creatorcontrib><creatorcontrib>Le Chenadec, Jérôme</creatorcontrib><creatorcontrib>ANRS EPF CO1/CO11 Study Group</creatorcontrib><creatorcontrib>ANRS EPF CO1/CO11 Study Group</creatorcontrib><title>Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Abstract Background Safety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy. Objectives To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC. Methods In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (&lt;50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC. Results Among 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was &lt;50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred. Conclusions In virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. 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Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy. Objectives To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC. Methods In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (&lt;50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC. Results Among 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was &lt;50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred. Conclusions In virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. 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subjects Human health and pathology
Life Sciences
title Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?
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