Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
Lancet HIV. 2022 Feb;9(2):e120-e129. doi: 10.1016/S2352-3018(21)00249-6. Epub 2021 Dec 2.
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.
抗逆转录病毒疗法（ART）在妊娠中的应用对于母婴健康非常重要，并且已经成功地将垂直传播率降低到几乎为零，只要孕妇能够坚持使用有效的 ART 方案。然而，HIV 感染者的低出生体重和早产率报告较高，而在妊娠中使用 ART 可能会进一步加重这种情况。蛋白酶抑制剂，特别是利托那韦增强的洛匹那韦，可能通过改变妊娠必需的甾体激素孕激素和雌二醇的血浆浓度，直接导致胎盘和子宫胎盘病理学的改变。在这篇综述中，我们汇集了越来越多的证据，证明蛋白酶抑制剂与母体内分泌失调、生殖生理学和胎盘功能障碍有关。基于胎盘和蜕膜作用的发现，我们建议根据美国和欧洲的指南，在妊娠中避免使用利托那韦增强的洛匹那韦。还建议对暴露于宫内蛋白酶抑制剂的儿童进行长期随访。
