Effect of Integrase Strand Transfer Inhibitor use on Time to HIV Viral Suppression before Delivery - Abstract
Background: We sought to determine if pregnant persons with HIV prescribed integrase strand transfer inhibitors (INSTI) antiretrovirals (ARVs) achieve viral suppression faster than persons taking non-INSTI regimens and to determine if there were differences in viral suppression at delivery between INSTI ARVs. Methods: This is a retrospective cohort study of pregnant persons with HIV who delivered a live infant during the study period (1/1/2009 to 12/31/2020). Persons’ ART was classified as including INSTI or non-INSTI. We compared the proportion of persons with viral suppression at delivery by group and individual INSTI ARVs using ?2 and Fischer’s exact tests. A log-rank test was used to compare time to viral suppression on ARVs. Results: During the study period, 168 persons delivered a live infant. Most persons were diagnosed with HIV before pregnancy and had taken ARVs before conception (76%), but less than half had an undetectable viral load at the first antenatal visit (45%). During pregnancy, 46% of persons were prescribed INSTI and 54% non-INSTI ARVs. Most persons had an undetectable HIV RNA viral load at delivery (75% INSTI and 72% non-INSTI, p=0.7). The time to viral suppression was similar between groups (LRT p=0.43). Viral suppression at delivery was similar between INSTI ARVs: raltegravir (53%), elvitegravir (88%), dolutegravir (73%), and bictegravir (88%) (p=0.13). Conclusion: Despite recommendations to prescribe INSTI in pregnancy for rapid viral suppression, we did not find a significant difference in time to viral suppression when pregnant persons were taking non-INSTI ARVs. We did not find that one INSTI ARV was superior.