Do Protease Inhibitors Increase Preterm Births in Human Immunodeficiency Virus-Infected Patients?


Objective: To compare preterm delivery (PTD) rates in HIV-infected patients on a protease inhibitor (PI)-based and a PI-sparing regimen. Study Design: This is a retrospective review of records of HIV-infected pregnant women between 2000 and 2007 at University Hospital, Newark, NJ. Patients were grouped according to PI exposure during pregnancy. Rates of preterm birth were compared, and the analysis was performed irrespectively of the etiology or indication of the preterm birth. Multivariate analysis including substance use, PI use, initial CD4 count, and history of PTD was performed. Results: There were 129 pregnant women in the PI group and 59 in the PI-sparing group. The PTD rate did not differ between the PI group and PI-sparing group (27.9% vs 25.4%, P = 0.72). 28.6% of those who delivered preterm had a previous PTD compared to 8.4% of those who delivered at term (P = 0.0019). Patients who delivered preterm had a higher rate of substance use (37.3% vs 19.7%, P = 0.0128). In the multivariate analysis, only history of PTD was significant (P = 0.018). Conclusion: Contrary to other studies, PIs were not associated with PTD. Other known risk factors of PTD, specifically past PTD and substance use, should be considered and targeted for risk reduction during pregnancy.

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S. Williams, B. Holland, U. Bozdogan, J. Alvarez, J. Apuzzio and A. Bardeguez, "Do Protease Inhibitors Increase Preterm Births in Human Immunodeficiency Virus-Infected Patients?," Advances in Infectious Diseases, Vol. 3 No. 3, 2013, pp. 172-176. doi: 10.4236/aid.2013.33025.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Perinatal HIV Guidelines Working Group, “Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States,” 2008, pp. 1-98.
[2] A. M. Cotter, A. G. Garcia, M. L. Duthely, B. Luke and M. J. O’Sullivan, “Is Antiretroviral Therapy during Pregnancy Associated with an Increased Risk of Preterm Delivery, Low Birth Weight or Stillbirth?” The Journal of Infectious Diseases, Vol. 193, No. 9, 2006, pp. 1195-1201. doi:10.1086/503045
[3] P. Lorenzi, V. M. Spicher, B. Laubereau, B. Hirschel, C. Kind, C. Rudin, et al., “Antiretroviral Therapies in Pregnancy: Maternal, Fetal and Neonatal Effects. Swiss HIV Cohort Study, the Swiss Collaborative HIV and Pregnancy Study, and the Swiss Neonatal HIV Study,” AIDS, Vol. 12, No. 18, 1998, pp. F241-F247. doi:10.1097/00002030-199818000-00002
[4] Centers for Disease Control and Prevention, “Enhanced Perinatal Surveillance—Participating Areas in the United States and Dependent Areas, 2000-2003,” HIV/AIDS Surveillance Supplemental Report, Vol. 13, No. 4, 2008, pp. 13-29.
[5] S. L. Bloom, N. P. Yost, D. D. McIntire and K. J. Leveno, “Recurrence of Preterm Birth in Singleton and Twin Pregnancies,” Obstetrics and Gynecology, Vol. 98, No. 3, 2001, pp. 379-385. doi:10.1016/S0029-7844(01)01466-1
[6] M. S. Esplin, E. O’Brien, A. Fraser, R. A. Kerber, E. Clark, S. E. Simonsen, et al., “Estimating Recurrence of Spontaneous Preterm Delivery,” Obstetrics and Gynecology, Vol. 112, No. 3, 2008, pp. 516-523. doi:10.1097/AOG.0b013e318184181a
[7] B. M. Mercer, R. L. Goldenberg, A. H. Moawad, P. J. Meis, J. D. Iams, A. F. Das, et al., “The Preterm Prediction Study: Effect of Gestational Age and Cause of Preterm Birth on Subsequent Obstetric Outcome. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network,” American Journal of Obstetrics and Gynecology, Vol. 181, No. 5, 1999, pp. 1216-1221.
[8] D. Ogunyemi and G. E. Hernandez-Loera, “The Impact of Antenatal Cocaine Use on Maternal Characteristics and Neonatal Outcomes,” The Journal of Maternal-Fetal & Neonatal Medicine, Vol. 15, No. 4, 2004, pp. 253-259. doi:10.1080/14767050410001668635
[9] M. E. Sprauve, M. K. Lindsay, S. Herbert and W. Graves, “Adverse Perinatal Outcome in Parturients Who Use Crack Cocaine,” Obstetrics and Gynecology, Vol. 89, No. 5, 1997, pp. 674-678.
[10] J. A. Bastek, M. D. Sammel, S. K. Srinivas and M. A. Elovitz, “Is Routine Infectious and Toxicologic Screening in Preterm Labor Effective in Predicting Preterm Birth?” American Journal of Obstetrics and Gynecology, Vol. 198, No. 5, 2008, pp. e38-e42. doi:10.1016/j.ajog.2007.10.777
[11] R. E. Tuomala, D. E. Shapiro, L. M. Mofenson, Y. Bryson, M. Culnane, M. D. Hughes, et al., “Antiretroviral theRapy during Pregnancy and the Risk of an Adverse Outcome,” The New England Journal of Medicine, Vol. 346, No. 24, 2002, pp. 1863-1870. doi:10.1056/NEJMoa991159
[12] J. Schulte, K. Dominguez, T. Sukalac, B. Bohannon and M. G. Fowler, for the Pediatric Spectrum of HIV Disease Consortium, “Declines in Low Birth Weight and Preterm Birth Among Infants Who Were Born to HIV-Infected Women During an Era of Increased Use of Maternal Antiretroviral Drugs: Pediatric Spectrum of HIV Disease, 1989-2004,” Pediatrics, Vol. 119, No. 4, 2007, pp. e900-e906. doi:10.1542/peds.2006-1123
[13] C. L. Townsend, M. Cortina-Borja, C. S. Peckham and P. A. Tookey, “Antiretroviral Therapy and Premature Delivery in Diagnosed HIV-Infected Women in the United Kingdom and Ireland,” AIDS, Vol. 21, No. 8, 2007, pp. 1019-1026. doi:10.1097/QAD.0b013e328133884b
[14] M. Ravizza, P. Martinelli, A. Bucceri, S. Fiore, S. Alberico, E. Tamburrini, et al., “Treatment with Protease Inhibitors and Coinfection with Hepatitis C Virus are Independent Predictors of Preterm Delivery in HIV-Infected Pregnant Women,” The Journal of Infectious Diseases, Vol. 195, No. 6, 2007, pp. 913-914. doi:10.1086/507045

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