Abstract and Introduction
Background: While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies.
Methods: The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'.
Results: We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception.
Conclusion: In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted.
In Canada during the last decade, the rate of vertical HIV transmission has decreased dramatically from 15% to 40% in antiretroviral (ARV)-naïve women to less than 1% for those receiving maternal ARV treatment with infant prophylaxis at birth. Several North American guidelines for ARV treatment and care of pregnant women living with HIV exist, including Canadian national guidelines,[3,4] provincial guidelines,[5,6] and the guidelines of the United States Department of Health and Human Services (HHS) Task Force. The HHS HIV perinatal guidelines are the most commonly used in Canada because they are updated annually and include recommendations on newly commercialized treatments. Since 2004, each of these guidelines recommends that all pregnant women living with HIV receive ARV treatment.[3–7]
In North America there are currently 24 ARV drugs approved for treating HIV, more than half of which have become available since 2015. While new ARV drugs have been systematically and comprehensively incorporated into some HIV treatment guidelines for adults in general, this has not been the case for guidelines for pregnant women specifically, mainly because of insufficient safety and efficacy data in this population.
The primary objective of this study was to describe Canadian prescribing practices regarding ARV treatment of HIV in pregnancy in comparison to HHS perinatal guideline recommendations available at the time. The secondary objective was to identify factors that could explain reasons for prescribing other than preferred/alternative ARV treatments.
HIV Medicine. 2023;24(2):130-138. © 2023 Blackwell Publishing