A recent study by researchers at Oxford Population Health’s Infectious Disease Epidemiology Unit has provided strong evidence supporting the World Health Organization (WHO) guidelines for treating pregnant women living with HIV. The study, published in Clinical Microbiology and Infection, addresses the efficacy of current antiretroviral therapy (ART) regimens in improving maternal health and reducing the transmission of HIV to babies.
Each year, an estimated 1.3 million women living with HIV are pregnant, most of whom reside in sub-Saharan Africa. Without proper treatment, pregnant women with HIV face higher risks of adverse perinatal outcomes, such as preterm birth, stillbirth, and babies born with low birth weight or smaller-than-expected size for their gestational age.
Since 2013, the WHO has recommended that all pregnant women living with HIV receive ART to improve maternal health and reduce the risk of vertical HIV transmission. This has led to a notable increase in the global proportion of pregnant women receiving ART, from 44% in 2010 to 82% in 2022. Despite these improvements, pregnant women with HIV still face an increased risk of adverse pregnancy outcomes compared to HIV-negative women.
The study aimed to fill an important evidence gap regarding the pregnancy outcomes associated with different antiretroviral drugs, particularly the nucleoside reverse transcriptase inhibitors (NRTIs) that are part of standard ART regimens. Although WHO guidelines recommend specific ART regimens for pregnant women, including tenofovir disoproxil fumarate (TDF) combined with either lamivudine (3TC) or emtricitabine (FTC) as the first-line treatment, there is limited data comparing the different NRTIs regarding their impact on pregnancy outcomes.
To address this gap, the researchers reviewed data from 22 cohort studies that investigated the impact of four NRTI drugs—tenofovir disoproxil fumarate (TDF), lamivudine (3TC), emtricitabine (FTC), and zidovudine (ZDV)—on perinatal outcomes. Their findings support the current WHO recommendations, particularly regarding the use of TDF in combination with 3TC or FTC as the preferred ART regimen for pregnant women with HIV. However, the study also highlighted that despite receiving ART, pregnant women with HIV still experience a higher risk of negative pregnancy outcomes when compared to HIV-negative women.
Joris Hemelaar, Associate Professor at Oxford Population Health and the senior author of the study, emphasized the importance of this research in confirming the effectiveness of the current guidelines but also noted that “further efforts should be made to improve outcomes for pregnant women with HIV.” He called for more extensive and larger randomised controlled trials to explore the impact of current ART regimens, as well as newer treatments like long-acting injectables and dual drug therapies, on a broader range of perinatal outcomes.
This research underscores the ongoing need for continued advancements in HIV treatment options for pregnant women, with the aim of improving maternal and infant health outcomes globally.
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