Antiretroviral therapy (ART) prescribing practices in the United States do not align with current national guidelines for approximately half of pregnant women with HIV, according to a study published in JAMA Network Open.
Treatment guidelines published by the Department of Health and Human Services (HHS) for pregnant women living with HIV have been available since 1994. The study aimed to examine ART prescribing practices over time among pregnant women living with HIV and identify factors associated with receiving recommended regimens.
For the analysis, the researchers used a cohort of 1582 pregnant women with HIV to examine the proportion of regimens prescribed that qualified as preferred or alternative regimens, according to HHS guidelines, stratified by timing of initiation.
According to the results, antiretroviral medications were initiated prior to conception for 42.3% of women, resumed during pregnant for 33.5%, and initiated during pregnancy for 24.2% of women. Overall, only 49.5% of pregnancies were associated with prescribed ART designated as preferred or alternative, whereas 26.4% involved ARTs with insufficient evidence for use during pregnancy and 7.3% involved ARTs that were not recommended during pregnancy.
Other findings showed:
- A higher proportion of treatment-naïve pregnant women initiating ART were prescribed preferred or alternative ARTs compared with those resuming treatment or those treated with ART before conception.
- A total of 20.1% of women initiating ART during pregnancy were prescribed ART with insufficient evidence for use during pregnancy or not recommended during pregnancy.
- Among women resuming ART, those with a viral load greater than 1000 copies/mL early in pregnancy had higher odds of being prescribed guideline-recommended ART (adjusted odds ratio, 2.03 [95% CI, 1.33-3.10]) compared with those with a viral load of 400 copies/mL or less.
The researchers wrote that the study findings suggest that US ART prescribing practices for pregnant women do not align well with the recommended national guidelines.
“This finding is particularly concerning when treatment is initiated during pregnancy,” they wrote. “Further research is needed to understand disparities between prescribing practices and evidence-based guideline recommendations.”
1. Powis KM, Huo Y, Williams PL, et al. Antiretroviral prescribing practices among pregnant women living with HIV in the United States, 2008-2017. JAMA Network Open. 2019. doi:10.1001/jamanetworkopen.2019.17669