Table of Contents Author Guidelines Submit a Manuscript
Infectious Diseases in Obstetrics and Gynecology
Volume 2009, Article ID 621780, 8 pages
http://dx.doi.org/10.1155/2009/621780
Clinical Study

Kinetics and Determining Factors of the Virologic Response to Antiretrovirals during Pregnancy

1Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
2Department of Pediatrics, The Children’s Hospital, Aurora, CO 80045, USA
3Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
4University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
5Department of Infectious Diseases, National Jewish Hospital, Denver, CO 80206, USA

Received 23 June 2009; Accepted 15 October 2009

Academic Editor: Grace John-Stewart

Copyright © 2009 Adriana Weinberg et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

HIV-infected pregnant women with undetectable plasma HIV RNA concentrations at delivery pose a minimal risk of vertical transmission. We studied the kinetics and the determinants of the virologic response to antiretroviral therapy in 117 consecutive pregnancies. Patients who initiated therapy during pregnancy had a VL decrease of 2 and 2.5 after 4 and 24 weeks, respectively. Therapeutic drug monitoring (TDM) of the protease inhibitors administered in doses recommended for nonpregnant adults resulted in below-target concentrations in 29%, 35%, and 44% of 1st, 2nd, and 3rd trimester measurements, respectively, but low drug concentrations did not correlate with virologic failure. Demographic characteristics, antiretroviral experience prior to pregnancy, baseline VL, or use of specific antiretrovirals did not affect the virologic response. Adherence to 95% of prescribed doses and utilization of psychosocial services were associated with undetectable plasma HIV RNA at delivery. In conclusion, the virologic responses of pregnant and nonpregnant adults share similar charactersitics.