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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 2

(480) Pregnancy outcomes in patients living with HIV managed with Atazanavir versus Darunavir-based antiretroviral therapy

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: Pregnant patients with HIV require effective antiretroviral therapy (ART) during pregnancy to prevent perinatal transmission and manage their own health, but the choice of regimen can impact pregnancy outcomes. Limited data are available comparing the safety and efficacy of second-generation protease-inhibitors (Atazanavir and Darunavir-based ART) in pregnancy despite their associated risks of hyperbilirubinemia and cholestasis. Therefore, we compared the maternal and neonatal outcomes in pregnant patients living with HIV managed with Atazanavir versus Darunavir-based ART.

Study Design:

This multi-center observational cohort study used data from 192 hospitals in 38 US states, sourced from the Vizient Clinical Database. We included pregnant patients with HIV on Atazanavir or Darunavir-based ART, who delivered between January 2021- April 2024. The primary outcome was intrahepatic cholestasis of pregnancy (ICP), with secondary outcomes including hypertensive disorders, preterm birth, and neonatal outcomes. We computed adjusted odds ratios (aOR) using multivariable logistic regression to adjust for potential confounders (maternal age, gestational age, diabetes mellitus, hypertension, baseline viral load and CD4 cell count).

Results: There were 251 patients in the Atazanavir and 218 patients in the Darunavir group. In the overall cohort at study entry, the median (interquartile range, IQR) maternal age was 31 (IQR 27-36) years with most patients identifying as Black (63.4%) . The frequency of ICP was similar in both groups (2.0% vs 2.8%; P=.59) - Table 1. The adjusted odds ratios (aOR) of ICP (aOR 1.83; 95% CI 0.51, 6.58), preterm birth (aOR 0.93; 95% CI 0.41, 2.12), gestational hypertension (aOR 0.82; 95% CI 0.44, 1.54), pre-eclampsia (aOR 1.07, 95% CI 0.58, 1.96), placental abruption (aOR 2.71; 95% CI 0.25, 28.93) and stillbirth (aOR 0.66; 95% CI 0.18, 2.25) were similar between both groups (Table 2).

Conclusion:

Atazanavir and Darunavir-based ART were safe for use during pregnancy and had similar pregnancy and neonatal outcomes.