Using the antiretroviral therapy (ART) in pregnant women and new mothers with human immunodeficiency virus (HIV) could increase risks of neonatal complications, including maternal mortality, neonatal mortality and low birth weight, an international study has revealed.
The World Health Organisation said standard antiretroviral therapy (ART), which consists of a combination of antiretroviral (ARV) drugs to maximally suppress the virus and stop the progression of HIV, has led to reduction in death rates. Officials from Mumbai confirmed the therapy has reduced the transmission from mother to child by 70% from 2010 to 2015. Mumbai has 44,522 pregnant women with HIV, of which 32,963 are on ART.
The study on a medical trial, Promoting Maternal and Infant Survival Everywhere (PROMISE), was published in the November issue of The New England Journal of Medicine. From April 2011 to September 10, 2014, the researchers enrolled 3,529 mother–infant sets from 14 sites in seven countries, including India and African countries, where the prevalence of HIV infection is known to be the highest. Around 100 women from BJ Medical College of Pune were part of the trial.
Dr Ramesh Bhosale, head of gynaecology and obstetrics department, BJ Medical College, who reported the findings from India said the women were put on three different drug regimes, of which two were multidrug ART regimes based on Zidovudine and Tenofovir. The results of ART regimes were then compared with Zidovudine alone drug therapy. “The outcomes revealed while HIV transmission from mother to child lowered in ART regimes, they also posed higher risk of adverse maternal and neonatal outcomes, including maternal mortality, neonatal mortality and low birth weight,” said Bhosale.
Dr Srikala Acharya, head, Mumbai District AIDS Control Society, said of the 488 deliveries of HIV-infected women in 2015, 17 babies contracted the virus, which is less than 5%. “The results of a study vary according to interim results of the same group, when followed after the period of the research. According to B+ treatment guidelines, which are currently followed by us, we have been able to cull the transmission rate, with no evident effect on mortality of morbidity of both mother and child,” said Acharya.
Dr Chandrashekhar Tulasigeri, consultant intensivist and critical care physician at Fortis Hiranandani Hospital, Vashi, said, “Any drug has its own set of side effects, but we need to collect more data to decide a final plan of action. Although statistically, the single drug regime looks promising, the multidrug treatment, under strict monitoring has managed to bring down the transmission rate of HIV virus to 0.5%.”