Efficacy of raltegravir in late‐presenting HIV‐infected pregnant women: a case series presentation

The risk of HIV perinatally transmition is highest in the 3rd trimester and is correlated with the imune status and especially with the maternal viral load close to delivery. The speed of the viral load decay is an importante strategy for the prevention of mother‐to‐child transmition (MTCT) in late‐presenting pregnant women. Poor access to prenatal care and HIV late diagnosis during pregnancy remains a major problem in Bahia, Brazil. The integrase inhibitor raltegravir has significantly higher first and second phase viral decay rates, has a high placental transfer with a potential preloading effect for neonate, and demonstrated effective accumulation in cervicovaginal secretions. These characteristics make RGV a potential candidate to treat late‐presenting pregant women. We report 13 cases in which raltegravir (400 mg twice daily) was used late in pregnancy, as part of the antirretroviral regimen for MTCT prophylaxis. Table 1 contains the main characteristics of the 13 cases. 1 Characteristics of the 13 cases. Numbers represent means (range)VariableMaternal age (yr) 28.6 (17–37) Years since HIV diagnosis 4.6 (<1–16) Week of pregnancy at RGV initiation 35.8 (34–38) Maternal CD4+ T‐cell count at RGV initiation (cl/ml) 357 (65–1.203) Maternal viral load at RGV initiation (cp/ml) 73.765 (636–391.535) Other ARV in regimen ZDV+3TC+LPV/r+RGV (7), ZDV+3TC+RGV (3), ZDV+3TC+DRV/r+RGV (2), ZDV+3TC+ATV+RGV (1) Exposure to RGV (days) 17.7 (7–35) Adverse events with RGV None Viral load at delivery (cp/ml) 181 (<50–457) Gestational age at delivery (wk) 38.3 (37‐40) Mode of delivery Elective C‐section (10), Non‐elective C‐section (2), Spontaneous vaginal delivery (1) Infant birth weight (kg) 2.942 (2.215–3.525) Obstetrical complications None Birth defects None Intravenus ZDV during labour and delivery Yes (13) Oral ZDV post‐exposure prophylaxis for infant Yes (13)Four mothers for whom viral load data were available had undetectable levels (<50 HIV‐RNA cp/ml) at the time of delivery. The remaining 9 women had viral load <460 cp/ml one week before delivery. All but one infant's HIV‐RNA were undetectable at 1 and 3 months. The only positive case was an intrauterine transmission, since the baby viral loads at birth and at 1 month were>500.000 cp/ml and mother had 64 cp/ml at delivery (elective C‐section). In conclusion, this and other previous reports suggest that RGV is an useful and safe ARV drug to reduce the MTCT in late‐presenting HIV‐infected pregnant women.