Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Rebecca M Zash, Paige L Williams, Jeanne Sibiude, Hermione Lyall, Fatima Kakkar, Rebecca M Zash, Paige L Williams, Jeanne Sibiude, Hermione Lyall, Fatima Kakkar

Abstract

The use of antiretroviral therapy (ART) in pregnancy to prevent vertical HIV transmission has been one of the most successful public health programs in the last decade. As a result, an unprecedented number of women are taking ART at conception and during pregnancy. Given few randomized studies evaluating safety of different ART regimens in pregnancy, ongoing drug safety surveillance is critical. Areas covered: This review aims to provide a rationale for ART drug safety surveillance, describe changing patterns of ART use and summarize current surveillance efforts in both low-resource and high-resource settings. Additionally, biostatistical approaches to and challenges in analysis of observational surveillance data are discussed. Expert opinion: The global landscape of ART use in pregnancy is rapidly increasing and evolving. Any increase in adverse effects of in-utero exposure to ART has the potential to reduce the impact of improvements in infant morbidity and mortality gained from decreased vertical HIV transmission. ART drug safety surveillance should therefore be a critical piece of programs to prevent mother to child transmission in both high- and low-resource settings. Current surveillance efforts could be strengthened with long-term follow-up of exposed children, pooling of data across cohorts and standardized approaches to analysis.

Keywords: HIV; antiretroviral therapy; infant safety; pregnancy; surveillance programs.

Conflict of interest statement

Declaration of Interest: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1
Figure 1
Increasing Percentage of HIV-infected women on Antiretroviral Treatment at Conception in the US and Botswana
Figure 2
Figure 2
Figure 2a. In utero Antiretroviral Exposure by Year of Birth in the US Surveillance Monitoring of ART Toxicities (SMARTT) Study Figure 2b. Antiretroviral (ART) Regimen Over Time in Botswana among Women on ART at Conception
Figure 2
Figure 2
Figure 2a. In utero Antiretroviral Exposure by Year of Birth in the US Surveillance Monitoring of ART Toxicities (SMARTT) Study Figure 2b. Antiretroviral (ART) Regimen Over Time in Botswana among Women on ART at Conception

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