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Infectious Diseases in Obstetrics and Gynecology
Volume 2012, Article ID 723096, 7 pages
http://dx.doi.org/10.1155/2012/723096
Research Article

Efavirenz Conceptions and Regimen Management in a Prospective Cohort of Women on Antiretroviral Therapy

1Wits Reproductive Health and HIV Institute, University of the Witwatersrand, 27516 Johannesburg, South Africa
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205 MD, USA

Received 19 January 2012; Revised 17 April 2012; Accepted 18 April 2012

Academic Editor: Susan Cu-Uvin

Copyright © 2012 Sheree Schwartz 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

Use of the antiretroviral drug efavirenz (EFV) is not recommended by the WHO or South African HIV treatment guidelines during the first trimester of pregnancy due to potential fetal teratogenicity; there is little evidence of how clinicians manage EFV-related fertility concerns. Women on antiretroviral therapy (ART) were enrolled into a prospective cohort in four public clinics in Johannesburg, South Africa. Fertility intentions, ART regimens, and pregnancy testing were routinely assessed during visits. Women reporting that they were trying to conceive while on EFV were referred for regimen changes. Kaplan-Meier estimators were used to assess incidence across ART regimens. From the 822 women with followup visits between August 2009–March 2011, 170 pregnancies were detected during study followup, including 56 EFV conceptions. Pregnancy incidence rates were comparable across EFV, nevirapine, and lopinavir/ritonavir person-years (95% 100/users ( )); incidence rates on EFV were 18.6 Confidence Interval: 14.2–24.2). Treatment substitution from EFV was made for 57 women, due to pregnancy intentions or actual pregnancy; however, regimen changes were not systematically applied across women. High rates of pregnancy on EFV and inconsistencies in treatment management suggest that clearer guidelines are needed regarding how to manage fertility-related issues in. women on EFV-based regimens.