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In women with HIV, antiretroviral therapy during pregnancy does not seem to cause congenital abnormalities, a recently published Latin American study suggests.

"The overall prevalence of congenital abnormalities in our study population is within the range reported among the general population in Latin America," the researchers point out. Stillbirths, too, were no more common with antiretroviral therapy.

JAIDSLead author Dr. Esau C. Joao of Hospital dos Servidores do Estado, Rio de Janeiro, Brazil, and colleagues came to this conclusion after studying 995 pregnant HIV-infected women and their infants in Argentina and Brazil. All were singleton pregnancies of 20 or more weeks of gestation, and 99.3% of the women received at least 1 antiretroviral during pregnancy.

The researchers report their findings in the December 21, 2009 online issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS).

Overall, at least one abnormality was detected either in the womb or after birth in 6% of pregnancies (59 live births and 1 stillbirth). The prevalence of abnormalities was 6.2 per 100 live births. When minor abnormalities were excluded, the rate per 100 live births fell to 5.8.

Consistent with findings in previous studies, the age of the fetus at first exposure to antiretrovirals had no impact on outcome. The prevalence (per 100 live births) after first, second and third trimester initiation of antiretrovirals was 6.2, 6.8 and 4.3, respectively.

"In addition," Dr. Joao told reporters, "the prevalence of congenital anomalies did not seem to differ significantly according to antiretroviral class, specific antiretrovirals, and any antiretroviral exposure."

Prevalence of congenital abnormalities in the general population

According to the research team, the overall prevalence of abnormalities was in line with reports from the general Latin American population, which range from less than 1% in studies based on birth certificates and medical records, to 2-3% in small retrospective cohort studies, to as high as 4.7% and 8.4% in larger reports from Brazil and Chile.

The authors also note that the prevalence of congenital abnormalities identified in the first 7 days after birth which was 2.4% was similar to the 2.8% at delivery documented by the Latin American Collaborative Study of Congenital Malformations, which reports on about 200,000 births per year.

The prevalence in this study was higher than in other studies of HIV-infected women and their offspring, however, possibly because this group studied the women prospectively, with infants followed for 6 months and both minor and major abnormalities recorded.

Dr. Joao told Reuters Health, "The results of our analyses do not support changes to current recommendations for the use of antiretrovirals during pregnancy for treatment of HIV-1-infected women and for prevention of mother-to-child transmission."

Still, he noted, "continued monitoring of the prevalence of congenital anomalies among children of HIV-1-infected women should be pursued."

Points to remember:

Antiretrovirals use for HIV in pregnancy appears safe

By Dr Joe Kabyemela, MD