Protease inhibitor-based antiretroviral therapy in pregnancy: effects on hormones, placenta, and decidua.
Lancet HIV
; 9(2): e120-e129, 2022 02.
Article
en En
| MEDLINE
| ID: mdl-34863352
ABSTRACT
The use of antiretroviral therapy (ART) in pregnancy is important for maternal health, and has been successful in reducing vertical transmission rates to almost zero in those taking effective ART regimens with good adherence. However, there are reports of higher rates of low birthweight and preterm births in women with HIV, which can be further exacerbated by ART usage in pregnancy. Protease inhibitors, and ritonavir-boosted lopinavir in particular, might directly contribute to placental and uteroplacental pathology in part by altering plasma concentrations of the essential steroid hormones of pregnancy, progesterone and oestradiol. In this Review, we collate the increasing evidence of dysregulated maternal endocrinology, reproductive physiology, and placental compromise associated with protease inhibitors. Based on findings of placental and decidual effects, we recommend that ritonavir-boosted lopinavir should be avoided in pregnancy, in line with US and European guidelines. Long-term follow-up of children exposed to protease inhibitors in utero is also recommended.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
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Inhibidores de la Proteasa del VIH
/
Fármacos Anti-VIH
Tipo de estudio:
Guideline
Límite:
Child
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Female
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Humans
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Newborn
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Pregnancy
Idioma:
En
Año:
2022
Tipo del documento:
Article