Journal
PLOS ONE
Volume 13, Issue 2, Pages -Publisher
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0192805
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Funding
- Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) [CDC-02-01-34-011-04]
- President's Emergency Plan for AIDS Relief (PEPFAR)
- United States Agency for International Development (USAID) [P3121A0028]
- Africa Health Research Institute [082384]
- Africa Centre [097410]
- Wellcome Trust [65377, 50535]
- South African Medical Research Council Clinician Researcher PhD Programme
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Objectives Increasingly more women conceive on antiretroviral therapy (ART) with non-nucleoside reverse transcriptase-based regimens. This study assessed the effect of preconception tenofovir disoproxil fumarate (TDF)-lamivudine (3TC)/emtricitabine (FTC)-efavirenz (EFV) and post-conception TDF-(3TC/FTC)-EFV (versus other regimens) on preterm delivery (PTD) and small-for-gestational age (SGA) births. Methods We analysed data of 2549 HIV-infected women attending antenatal clinics in KwaZulu-Natal from 2010 through 2015 in this retrospective cohort study. Preconception, TDF-(3TC/FTC)EFV was compared to nevirapine (NVP)-based regimens and other 3-drug EFV-based regimens. Post-conception, TDF-(3TC/FTC)-EFV was compared to NVP-based ART and zidovudine (ZDV) prophylaxis. Outcomes included PTD <37 weeks and SGA births. Generalized linear mixed effects were used to fit logistic regression models to account for repeat pregnancies. Results Among 2549 singleton live births, 10.4% (n = 264) were PTD and 10.4% (n = 265) SGA. PTD declined from 16.3% in 2010 to 9.3% in 2015 and SGA remained stable from 9.9% in 2010 to 10% in 2015. Preconception NVP-based regimens [adjusted odds ratio (aOR) 0.66; 95% CI 0.27 +/- 1.63] and other 3-drug EFV-based regimens (aOR 0.72; 95% CI 0.24 +/- 2.12) were not associated with PTD versus TDF-(3TC/FTC)-EFV. NVP-based (aOR 0.75; 95% CI 0.40 +/- 1.42) and other 3-drug EFV-based regimens (aOR 1.55; 95% CI 0.76 +/- 3.16) were not associated with SGA births versus TDF-(3TC/FTC)-EFV. Post-conception NVP-based ART (1.77; 95% CI 0.89 +/- 3.51) and ZDV (1.03; 95% CI 0.68 +/- 1.58) were not associated with PTD versus TDF-(3TC/FTC)-EFV. NVP-based ART (1.55; 95% CI 0.66 +/- 3.61) and ZDV (0.89; 95% CI 0.53 +/- 1.47) were not associated with SGA versus TDF-(3TC/FTC)-EFV. Conclusions Preconception TDF-(3TC/FTC)-EFV and post-conception TDF-(3TC/FTC)-EFV were not associated with PTD or SGA, compared with other regimens. Increasing ART use merits further study of the optimum ART regimen for safe birth outcomes.
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