Use of Raltegravir in HIV-Infected Pregnant Women: A Case Series and Review of the Literature

Abstract

Objective: To evaluate the safety and tolerability of RAL therapy and the rapidity with which RAL decreases viral load in HIV-infected pregnant women. Methods: Women were considered for inclusion in the study if they were HIV-seropositive, >=18 years of age, and received RAL during pregnancy. Men, non-pregnant women, or those that did not meet the inclusion criteria were not considered. HIV viral load, CD4 count (absolute), pregnancy demographics, antiretroviral regimens, adverse events, liver function enzymes, and APGAR scores were collected. Results: Eight HIV-infected RAL-naive pregnant women presented between 6 to 39.4 weeks gestational age with a median RNA viral load of 41,083 copies/mL at the initiation of RAL. From the initiation of RAL until delivery, the median decline in RNA viral load was 1.60 log. At delivery, two patients reached <48 copies/mL and two had <500 copies/mL. The median RNA viral load at delivery was 911 copies/mL. No adverse events in the mother or neonate due to RAL therapy were noted during this study. Conclusions: These results support the safe and efficacious addition of RAL to HAART regimen to decrease RNA viral load late in pregnancy if a patient is not yet virologically suppressed. Further prospective study is needed.