Samuel Miriam, Bradshaw Daniel, Perry Melissa, Chan Sum Yee, Dhairyawan Rageshri, Byrne Laura, Smith Katherine, Zhou Judith, Short Charlotte Eve, Naftalin Claire, Offodile Ngozi, Mandalia Sundhiya, Roedling Sherie, Shah Rimi, Brook Gary, Poulton Mary, Rodgers Mette, Sarner Liat, Noble Heather, Hay Philip, Anderson Jane, Natha Macky, Hawkins David, Taylor Graham, de Ruiter Annemiek
Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
Infect Dis Obstet Gynecol. 2014;2014:961375. doi: 10.1155/2014/961375. Epub 2014 Sep 25.
There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy.
A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010.
There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), "preconception" atazanavir exposure; 27 started atazanavir-based cART as "first-line" during the pregnancy; and 29 "switched" to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman.
These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy.
关于产前使用阿扎那韦的耐受性、安全性或疗效的数据很少。我们报告了在妊娠期间使用阿扎那韦的临床经验。
对2004年至2010年间伦敦12个中心接受阿扎那韦治疗的妊娠病例进行回顾性病历审查。
135名女性中有145例妊娠：89例在接受基于阿扎那韦的联合抗逆转录病毒疗法（cART）时受孕，即“受孕前”暴露于阿扎那韦；27例在妊娠期间开始使用基于阿扎那韦的cART作为“一线”治疗；29例在妊娠期间从另一种cART方案“转换”为基于阿扎那韦的方案。5例妊娠因胃肠道不耐受而停用阿扎那韦。自限性新发转氨酶升高在一线治疗中最为常见，发生率为11.0%。在5例转氨酶升高的转换妊娠中开始使用阿扎那韦，其中2例因转氨酶持续升高而停用阿扎那韦。受孕前暴露组、一线治疗组和转换暴露组的HIV病毒载量<50拷贝/mL的比例分别为89.3%、56.5%和72.0%。单胎早产（<37周）在受孕前暴露组、一线治疗组和转换暴露组中的发生率分别为11.7%、9.1%和7.7%。4名婴儿需要光疗。1名依从性差的女性发生了母婴传播。
这些数据表明，阿扎那韦耐受性良好，可作为妊娠期间联合抗逆转录病毒治疗的一部分安全使用。
