Posts tagged medication during pregnancy
Low Risk of Birth Defects: HIV and Antiretroviral Medication
With new compounds and therapies expanding what can be done for individuals living with HIV, more and more infected women are looking towards pregnancy and childbirth. The combination of pregnancy and the latest antiviral medications is always a cause of concern, as we often don’t have enough data to make a definitive decision on whether a certain medicine should be given to an individual while pregnant. We also need to know when it is most likely for a mother to infect her infant, and which medicines are best at keeping the rate of infection low. Certainly, many antiretroviral drugs developed in the fight against HIV have been thought to increase the potential of birth defects in the unborn children. A new study, however, shows the opposite. Indeed, it confirms a low risk of birth defects by antiretroviral medications used during pregnancy.
This study – the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring of ART Toxicities (SMARTT) study – released its findings on 10 November 2014. Atazanavir was the only antiretroviral drug that was shown to increase the otherwise low risk of birth defects among HIV-positive women. This medication showed a 2-fold increase in the risk of birth defects, particularly musculoskeletal and skin anomalies. However, another study confirmed that at least three varied regimens of anti-HIV medications—that did not include atazanavir—was safe for women who are expecting. In fact, all other antiretroviral, anti-HIV medications tested in these studies showed no increase in the risk of birth defects. This is great news for HIV infected women who still want to become mothers. With the risks of infecting their child minimal, and the side effects almost non-existent, the hopes of researchers are high that we will find ways to altogether eliminate the transfer of HIV between mother and child.
Alternative HIV Regimens: For Those Unable to Use Efavirenz
The most commonly prescribed HIV therapies includes efavirenz, which is one of the key ingredients in stopping the spread of HIV cells through the body and keeping the immune system functioning and optimal. Efavirenz is never prescribed alone, however in combination with other anti-HIV drugs it has proven to have the greatest overall results in keeping the HIV viral load down and the immune response minimal. Unfortunately, the side effects can prevent some people from taking efavirenz. The adverse effects can include insomnia, nightmares, confusion, memory loss, headaches and depression. Along with these psychiatric disorders, efavirenz has also been known to cause birth defects in children whose mothers used the drug. Because of these consequences, it is highly recommended that anybody who suffers from certain psychiatric conditions, or any woman who believes they are pregnant, or are trying to pregnant, should not take efavirenz. Luckily, for patients who are HIV positive and unable to take efavirenz, there are alternative HIV regimens found to be effective in keeping the virus under control and unable to attack the immune system.
Researchers at the AIDS Clinic Trials Group (ACTG), have conducted a Phase III, randomized study of regimens which do not use efavirenz. They studied three different therapies given to over 1,800 HIV positive adults. The results were uniformly positive. The in-depth study closely followed the participants for 96 weeks. At the end of the study, it was ascertained that all three regimens were effective in keeping the viral loads down and keeping the immune systems healthy. There were variations in how easily patients were able to withstand any negative effects of the drugs while still gaining all of the positive effects. One regimen was clearly superior in this category – the raltegravir-based therapy – but all three were reasonable for lifelong medical regimens. These alternative HIV regimens that are effective in patients not eligible for efavirenz has provided another outlet of hope for first line defense against HIV infection.
A recent study addressed concerns on the effect that an expectant mother’s HIV treatment may have on her unborn baby. In particular, the study focused on language development. What was the result? By age two, children who had been born to mothers treated for HIV during pregnancy showed no additional delay in learning to speak.
This was an important study to relieve the concerns of many in the medical field. It had been believed that treating pregnant women for HIV would result in the baby’s lessened brain development.
All of the children who were part of the study were exposed to HIV during the pregnancy. While some mothers received a cocktail of drugs to treat the condition; others did not. The results for language development in the resulting children were just about equal. On both sides, about 1 in 4 experienced development difficulties. This shows that it was not the medication’s fault that children born to HIV-infected were having this language problem.
While previous studies suggested that the antiretroviral drugs may cause these delays, this study has clearly debunked that previous concern. One drug in particular is still being monitored, however. While children born of mothers on this particular drug were on equal footing with their peers by age two, they were behind at age one and had to catch up. More research is necessary to discover the reason for this. The drug’s name is Atazanavir.
Almost 800 children were a part of this comprehensive study, so these findings clearly overturn those of previous smaller studies. On the other hand, now research must continue to try and explain why about 25% of children exposed to HIV in the womb end up experiencing some kind of early on language problem.