Introduction
Bictegravir (BIC) is recommended as first-line therapy for use in treatment-naïve patients and those with viral suppression. Perinatal HIV guideline recommend it as an alternative ARV regimen in pregnancy.
Aim
Describe maternal viral suppression and perinatal outcomes in people using BIC during pregnancy
Patient Profile
Pregnant patient who presented for care between Jan 1, 2019, and Jan9, 2023 received BIC at any point during pregnancy.
Methods
- Multicenter retrospective review
- Outcomes of 147 pregnancies were analysed according to timing of BIC use in pregnancy:
- Preconception BIC with continued use in pregnancy,
- Started BIC during pregnancy,
- Preconception BIC but discontinued during pregnancy.
- The HIV outcomes included were viral load, CD4 count, route of transmission and rate of perinatal transmission.
- Gestational age at delivery, birth weight, route of delivery, and birth anomalies were perinatal outcomes -evaluated.
Results
- The use of BIC in pregnancy was associated with high levels of viral suppression.
- Patients in preconception BIC with continued use in pregnancy group had the highest frequency of viral suppression at delivery
Table 1 : HIV outcomes with use of bictegravir in pregnancy
|
|
Preconception BIC with continued use in pregnancy |
Started BIC during pregnancy |
Preconception BIC but discontinued during pregnancy |
Overall |
|
HIV-1 RNA viral load <50 copies/mL on entry to prenatal care |
79.2 |
23.2 |
80 |
57.3 |
|
HIV-1 RNA viral load <200 copies/mL on entry to prenatal car |
85.3 |
28.6 |
100 |
63.6 |
|
CD4 <200 cells/mm3 at prenatal care entry |
4.9 |
22.4 |
0 |
11.8 |
|
HIV-1 RNA viral load <50 delivery copies/mL at delivery |
96.2 |
84.7 |
60 |
90.3 |
|
HIV viral load <200 copies/mL at delivery |
97.5 |
91.5 |
80 |
94.5 |
Table 2: Perinatal outcomes with use of bictegravir in pregnancy
|
Perinatal Outcomes |
Overall |
Preconception BIC with continued use in pregnancy |
Started BIC during pregnancy |
Preconception BIC but discontinued during pregnancy |
|
Mean gestational age at delivery in weeks |
38.1 |
38.1 |
37.9 |
39 |
|
Mean birth weight in grams |
3043 |
3126 |
3176 |
2911 |
|
Rate of preterm birth (delivery at <37 weeks) |
17.7 |
19.2 |
16.9 |
0% |
|
Caesarean deliveries |
6 |
0 |
5 |
1 |
|
Infant Outcomes |
|
|
|
|
|
Rate of foetal anomalies |
4.1 |
2.4 |
6.7 |
0 |
|
Perinatal HIV Transmission |
0.7 |
0 |
1.7 |
0 |
Conclusion
- BIC used during pregnancy demonstrated high viral suppression and favourable safety profile supporting its use in the management of HIV during pregnancy.
Reference
Clin Infect Dis, 2024; ciae218, https://doi.org/10.1093/cid/ciae218
