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Protease inhibitor therapy and fetal growth potential in HIV-positive women

Sara Iqbal1, Jan Kriebs, Christopher Harman

  • 1Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA.

American Journal of Perinatology
|May 30, 2008
PubMed

Insights

Protease inhibitors (PIs) may increase fetal growth restriction (FGR) risk in HIV-positive women. Maternal CD4 count and smoking are primary FGR determinants, with PIs potentially increasing risk based on disease severity.

Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Neonatology

Background:

  • Human immunodeficiency virus (HIV) infection in pregnant women presents unique challenges for fetal well-being.
  • Fetal growth restriction (FGR) is a significant concern, impacting neonatal outcomes.
  • The role of antiretroviral therapy, specifically protease inhibitors (PIs), in FGR incidence requires further investigation.

Purpose of the Study:

  • To determine if protease inhibitors (PIs) are associated with an increased incidence of fetal growth restriction (FGR) in HIV-seropositive women.
  • To identify maternal factors, including CD4 count and smoking, that contribute to FGR risk.
  • To analyze the independent contribution of PIs to FGR after accounting for disease severity.

Main Methods:

  • Retrospective study of 191 HIV-seropositive pregnant women.
  • Fetal growth restriction (FGR) defined as neonatal weight percentile < 10% based on predicted growth potential.
  • Statistical analysis using chi-square and multiple regression to assess relationships between maternal factors (age, CD4 count, viral load, PI use, smoking) and FGR.

Main Results:

  • FGR incidence was higher in women receiving PIs (29%) compared to non-PI users (15.3%) (P=0.02).
  • Maternal CD4 count (P<0.0001) and smoking (P=0.037) were primary determinants of FGR.
  • Smokers had a significantly higher odds of FGR (OR 2.69; P=0.005).
  • PI use became a significant cofactor for FGR (P=0.021) after excluding CD4 count, suggesting a link to maternal disease severity.

Conclusions:

  • Maternal HIV status and smoking are key determinants of FGR risk.
  • Protease inhibitor use is associated with increased FGR incidence, particularly in women with more severe HIV disease.
  • Further research is needed to elucidate the mechanisms by which PIs influence fetal growth in the context of maternal HIV severity.

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