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Practice Rapid Recommendations

Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3961 (Published 11 September 2017) Cite this as: BMJ 2017;358:j3961

Drug names

There are a large number of different antiretroviral drugs used by people with HIV. These drug names and abbreviations will be used throughout this article. Protease inhibitors(PIs) Nucleoside reverse transcriptase inhibitors(NRTIs) TDF FTC AZT 3TC TenofovirEmtricitabine Zidovudine LamivudineAbacavir Non-nucleoside reverse transcriptase inhibitors (NNRTIs) LPV/r Lopinavir (boosted with ritonavir) ATZ/r EFV DRV/r RAL RPV ABC Atazanavir (boosted with ritonavir) Darunavir (boosted with ritonavir) Efavirenz Rilpivirine Integrase inhibitors Raltegravir

Population

Pregnant womenliving with HIV Already recieving combination antiretroviral therapy (cART) New diagnosis / not recieving cART at least one additional antiretroviral CD4≥ 350 This recommendation compares different combined antiretroviral medications that may be given to women during pregnancy, to reduce the risk of vertical transmission to the child. Intrapartum antiretroviral therapy only Generally not recommended.Vertical transmission ≈ 50–300 babies in 1000 or Combination antiretroviral therapy (cART) at least one additional antiretroviral at least one additional antiretroviral + + + + Vertical transmission ≈ 5 babies in 1000.No increased vertical transmission with vaginal delivery or breastfeeding.Possible increase in premature birth compared to AZT monotherapy or no maternal ART (particularly with protease inhibitors) CD4< 350 For women with low CD4 levels, cART may reduce AIDS-defining illness.cART may also reduce maternal mortality, especially if CD4 level is below 200 mono-therapy Vertical transmission ≈ 10–15 babies in 1000 AZT Nucleoside reverse transcriptase inhibitor Zidovudine AZT TDF Nucleoside reverse transcriptase inhibitor Tenofovir TDF FTC Nucleoside reverse transcriptase inhibitor Lamivudine FTC AZT Nucleoside reverse transcriptase inhibitor Zidovudine AZT 3TC Nucleoside reverse transcriptase inhibitor Lamivudine 3TC

Recommendation 1

or TDF + FTC- based therapy AZT + 3TC- based therapy Zidovudine + lamivudine-based antiretroviral therapy. Tenofovir + emtricitabine-based antiretroviral therapy. TDF FTC + Treatment backbone: Combined with one of: ATZ/r EFV DRV/r RAL RPV AZT 3TC + Treatment backbone: Combined with one of: LPV/r ATZ/r EFV DRV/r RAL RPV ABC or TDF + FTC- based therapy AZT + 3TC- based therapy Zidovudine + lamivudine-based antiretroviral therapy. Tenofovir + emtricitabine-based antiretroviral therapy. Favours TDF + FTC cART Favours AZT + 3TC cART + Treatment backbone: Combined with one of: + Treatment backbone: Combined with one of: ABC Nucleoside reverse transcriptase inhibitor Abacavir ABC RPV Non-nucleoside reverse transcriptase inhibitor Rilpivirine RPV EFV Non-nucleoside reverse transcriptase inhibitor Efavirenz EFV RAL Integrase inhibitor Raltegravir RAL ATZ/r Protease inhibitor Atazanavir (boosted with ritonavir) ATZ/r DRV/r Protease inhibitor Darunavir (boosted with ritonavir) DRV/r LPV/r Protease inhibitor Lopinavir (boosted with ritonavir) LPV/r 3TC Nucleoside reverse transcriptase inhibitor Lamivudine 3TC AZT Nucleoside reverse transcriptase inhibitor Zidovudine AZT RPV Non-nucleoside reverse transcriptase inhibitor Rilpivirine RPV EFV Non-nucleoside reverse transcriptase inhibitor Efavirenz EFV RAL Integrase inhibitor Raltegravir RAL ATZ/r Protease inhibitor Atazanavir (boosted with ritonavir) ATZ/r DRV/r Protease inhibitor Darunavir (boosted with ritonavir) DRV/r TDF Nucleoside reverse transcriptase inhibitor Tenofovir TDF FTC Nucleoside reverse transcriptase inhibitor Emtricitabine FTC

Strong Weak We suggest a zidovudine and lamivudine-based antiretroviral regimen over one that includes tenofovir and emtricitabine All Applies to Click fordetails Weak Benefits outweigh harms for the majority, but not for everyone. The majority of patients would likely want this option. Strong Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option.

Comparison of benefits and harms

Favours TDF + FTC cART Favours AZT + 3TC cART Events per 1000 people All settings Evidence quality No important difference The panel found that these differences were not important for most patients, because the intervention effects were negligible and/or very imprecise (such as statistically not significant)

HIV vertical transmission 5 4 No important difference Low More

Risk of Bias No serious concerns Imprecision No serious concerns Indirectness Possible Inconsistency No serious concerns Publication bias No serious concerns There may not be an important difference in vertical HIV transmission based mainly onobservational data Additionalconcerns +

Maternal laboratory AEs Moderate 117 138 No important difference More

Risk of Bias No serious concerns Imprecision Serious Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns There may not be an important difference in maternal serious laboratory adverse events

Maternal clinical AEs Moderate 20 20 No important difference More

Risk of Bias No serious concerns Imprecision No serious concerns Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns There is probably no important difference in maternal serious clinical adverse events

Premature births (<34 weeks) Low 74 42 fewer 32 More

Risk of Bias No serious concerns Imprecision Serious Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns There may not be an important increase in early prematurity with TDF/FTC
Low/medium resourced settings Events per 1000 people Evidence quality

Hepatitis B vertical transmission Low 111 No important difference 29 More

Risk of Bias No serious concerns Imprecision Very serious Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There may not be an important difference in vertical hepatitis B transmission

Stillbirth/neonatal mortality Low 304 235 fewer 69 More

Risk of Bias No serious concerns Imprecision Serious Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns TDF/FTC may increase the risk of stillbirth and early neonatal mortality
High resourced settings Events per 1000 people Evidence quality

Hepatitis B vertical transmission Moderate 3 10 No important difference More

Risk of Bias No serious concerns Imprecision Serious Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There is probably no important difference in vertical hepatitis B transmission

Stillbirth/neonatal mortality Low 66 51 fewer 15 More

Risk of Bias No serious concerns Imprecision Serious Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns TDF/FTC may increase the risk of stillbirth and early neonatal mortality
See all outcomes
Women in these situations might be more likely to choose regimens with a tenofovir/emtricitabine backbone: Preferences and values Resourcing Other considerations Zidovudine/lamivudine is available as a low-cost generic around the world, while tenofovir/emtricitabine remains on patent in several countries. The evidence applies less in areas with high hepatitis B disease activity, high resource settings, or where access to one of the options is limited. Lamivudine-resistant hepatitis B Severe anemia Lamivudine-resistant HIV Drug allergy Women taking other medications with serious interactions Women who place a high value on a once-daily regimen Zidovudine-resistant HIV Alternatives are not available

Recommendation 2

or TDF + FTC + LPV/r The specific combination of drugs tested in the PROMISE trial TDF FTC + Treatment backbone: Combined with: AZT + 3TC- based therapy Zidovudine + lamivudine-based antiretroviral therapy. AZT 3TC + Treatment backbone: Combined with one of: LPV/r ATZ/r EFV DRV/r RAL RPV ABC Favours TDF + FTC + LPV/r Favours AZT + 3TC cART LPV/r Protease inhibitor Lopinavir (boosted with ritonavir) LPV/r ABC Nucleoside reverse transcriptase inhibitor Abacavir ABC RPV Non-nucleoside reverse transcriptase inhibitor Rilpivirine RPV EFV Non-nucleoside reverse transcriptase inhibitor Efavirenz EFV RAL Integrase inhibitor Raltegravir RAL ATZ/r Protease inhibitor Atazanavir (boosted with ritonavir) ATZ/r DRV/r Protease inhibitor Darunavir (boosted with ritonavir) DRV/r LPV/r Protease inhibitor Lopinavir (boosted with ritonavir) LPV/r 3TC Nucleoside reverse transcriptase inhibitor Lamivudine 3TC AZT Nucleoside reverse transcriptase inhibitor Zidovudine AZT TDF Nucleoside reverse transcriptase inhibitor Tenofovir TDF FTC Nucleoside reverse transcriptase inhibitor Emtricitabine FTC

Strong Weak We recommend a zidovudine and lamivudine-based antiretroviral regimen over tenofovir and emtricitabine with ritonavir-boosted lopinavir All Applies to Click fordetails Weak Benefits outweigh harms for the majority, but not for everyone. The majority of patients would likely want this option. Strong Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option.

Comparison of benefits and harms

Favours TDF + FTC + LPV/r Favours AZT + 3TC cART Events per 1000 people All settings Evidence quality No important difference The panel found that these differences were not important for most patients, because the intervention effects were negligible and/or very imprecise (such as statistically not significant)

HIV vertical transmission 5 4 No important difference Low More

Risk of Bias Possible Imprecision No serious concerns Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There may not be an important difference in vertical HIV transmission based mainly onobservational data Additionalconcerns +

Maternal laboratory AEs Moderate 117 138 No important difference More

Risk of Bias No serious concerns Imprecision Serious Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There is probably no important difference in maternal serious laboratory adverse events

Maternal clinical AEs Moderate 20 20 No important difference More

Risk of Bias No serious concerns Imprecision No serious concerns Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns There is probably no important difference in maternal clinical adverse events

Premature births (<34 weeks) Moderate 74 42 fewer 32 More

Risk of Bias No serious concerns Imprecision Serious Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There is probably an important increase in early prematurity with TDF/FTC
Low/medium resourced settings Events per 1000 people Evidence quality

Hepatitis B vertical transmission Low 29 111 No important difference

Risk of Bias No serious concerns Imprecision Very serious Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There may not be an important difference in vertical hepatitis B transmission

Stillbirth/neonatal mortality Moderate 304 235 fewer 69 More

Risk of Bias No serious concerns Imprecision Serious Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns TDF/FTC probably increases the risk of stillbirth and early neonatal mortality
High resourced settings Events per 1000 people Evidence quality

Hepatitis B vertical transmission Moderate 3 10 No important difference More

Risk of Bias No serious concerns Imprecision Serious Indirectness No serious concerns Inconsistency No serious concerns Publication bias No serious concerns There is probably no important difference in vertical hepatitis B transmission

Stillbirth/neonatal mortality Moderate 66 51 fewer 15

Risk of Bias No serious concerns Imprecision Serious Indirectness Serious Inconsistency No serious concerns Publication bias No serious concerns TDF/FTC probably increases the risk of stillbirth and early neonatal mortality
See all outcomes
Women in these situations might be more likely to choose regimens with a tenofovir/emtricitabine backbone: Preferences and values Resourcing Other considerations Zidovudine/lamivudine is available as a low-cost generic around the world, while tenofovir/emtricitabine remains on patent in several countries. The evidence applies less in areas with high hepatitis B disease activity, high resource settings, or where access to one of the options is limited. Lamivudine-resistant hepatitis B Severe anemia Lamivudine-resistant HIV Drug allergy Women taking other medications with serious interactions Women who place a high value on a once-daily regimen Zidovudine-resistant HIV Alternatives are not available

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Rapid Response:

Authors respond to "Comment from PROMISE team" Re: Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline

Dear Editor:

We thank Dr. Fowler and colleagues for taking the time to consider and comment on our BMJ Rapid Recommendation (1). They speculate on reasons why tenofovir and emtricitabine increased the risk of neonatal mortality and early preterm delivery in their trial (2) and then say that the current evidence does not support a recommendation for alternative NRTIs over a tenofovir-based antiretroviral therapy (ART) regimen. We do agree that most, but not all, of the evidence comes from a single study, which may have overestimated harm. Our systematic review attempted to generate the current best evidence, and is not definitive: it is moderate-to-low quality for key outcomes (3). However, we disagree with the implication that based on this evidence, most women would choose a tenofovir-based ART regimen.

The PROMISE authors suggest that results of the comparison between tenofovir-ART and AZT-ART are untrustworthy because the risk of neonatal death was lower in the AZT-ART arm in the earlier period 1 before the tenofovir-ART arm was introduced (2). However, the difference between the two time-periods in the AZT-ART arm could easily be explained by chance (neonatal mortality 1.4% in period 1 vs. 0.6% in period 2, p=0.39; very preterm delivery 3.4% in period 1 vs. 2.6% in period 2, p=0.60). Regardless, the only reliable comparison between tenofovir-ART and AZT-ART is during period 2 when randomisation to both AZT and tenofovir-based ART occurred. Despite these reservations, we performed sensitivity analyses that included data from the AZT-arm in period 1 before the tenofovir-ART arm was introduced (3). The increased risk of early preterm delivery and stillbirth with tenofovir/emtricitabine remained statistically significant and interpretation does not change when data from period 1 is included. Dr. Fowler and colleagues have also suggested that there may have been “some unknown confounder” wherein tenofovir-ART caused harm during period 2, but would not have been harmful to the participants in period 1 (2, 4). We consider this unlikely. Even if true, no such confounder has been identified and women faced with choosing an ART regimen will not know whether or not tenofovir-ART has the potential for harm in their case.

We agree that when tenofovir and emtricitabine are used in combination with lopinavir/ritonavir, it is possible that the risk is higher than with efavirenz; although it is unlikely that if tenofovir is indeed the ‘culprit’ medication, that there would be no risk at all when combined with efavirenz. Put another way, even if the risk of premature delivery and neonatal death is low with tenofovir/emtricitabine plus efavirenz, based on the available evidence, the risk with AZT/lamivudine plus efavirenz may be even lower.

We did not state that the pathophysiology of stillbirth and early neonatal death are the same. Perinatal mortality has long been a global standard outcome measure of maternal and perinatal healthcare (5) and is likely to be similarly important to women, thus our panel pre-specified that it was appropriate to combine them in our evidence summary.

We agree with their concern regarding the possibility that all combination ART regimens may increase the risk of prematurity (versus no ART or monotherapy), albeit this is uncertain and not the focus of this guidance. Given the unique physiology (and pathophysiologies) of pregnancy, the lack of an understood biological rationale at this stage should neither lead to a definitive conclusion nor reassurance. It remains possible that potential pharmacokinetic interactions, and failing or restoring immune systems are different in pregnancy. These are all good reasons to recognise that work from non-pregnant male and female adults cannot always be applied directly to pregnant women. Instead, these are strong justifications for further pregnancy-specific research. We believe that pregnant women (and their babies) should have an equitable standard of research evidence, and thus disagree that it is unlikely that there will be other randomised trials. It is imperative that further randomised trials are conducted. Regulatory authorities, and perhaps the WHO, have a responsibility to ensure that the appropriate studies are performed by the pharmaceutical industry to ensure that pregnant women are not disadvantaged.

Fowler et al. assert that the available observational evidence should provide reassurance to pregnant women. In this, we believe they are misguided. We reviewed the entirety of the observational evidence, including the single observational study that they cite (6); it cannot provide such assurance. First, even the highest quality observational studies are at high risk of residual confounding (7). Second, none of the studies controlled for all of the most important known confounders, including HIV disease status (CD4 count and viral load), socioeconomic status, and availability and quality of healthcare. Third, the studies were inconsistent with some showing harm with tenofovir and others benefit. Fourth, the results were imprecise with the confidence intervals including a magnitude of harm that almost all women would find important.

We strongly disagree with any implication that most women would be willing to risk the health of their child when other options exist. The decision about which vertical transmission strategy or combination ART regimen to use should rest squarely with each informed woman, based on her own values and preferences. This message was consistent from the linked systematic review on the values and preferences of women living with HIV (8), from the three women living with HIV on the guideline panel, as well as an associated opinion piece written by a woman living with HIV (9). Avoiding death in a newborn child is tremendously important to all or almost all women and even if the increased risk of stillbirth or neonatal mortality is extremely low with tenofovir/emtricitabine, almost all women would choose to use a different regimen. Unless future randomised trials show that tenofovir/emtricitabine is safe, we believe that most fully informed women would choose an alternative. Efforts should be made to share the best available evidence and empower women who are pregnant or might consider pregnancy to choose their medications for themselves rather than a ” one size fits all” approach to HIV treatment.

Sincerely,
Reed A.C. Siemieniuk, Graham P. Taylor, Gordon H. Guyatt, Lyubov Lytvyn, Yaping Chang, Paul E. Alexander, Yung Lee, Thomas Agoritsas, Arnaud Merglen, Haresh Kirpalani, Susan Bewley

References
1. Siemieniuk RA, Lytuyn L, Ming JM et al. Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline. BMJ 2017;358:j3961.

2. Fowler MG, Qin M, Fiscus SA, et al. Benefits and risks of antiretroviral therapy for perinatal prevention. N Engl J Med 2016;375:1726-37.

3. Siemieniuk RA, Foroutan F, Mirza R et al. Antiretroviral therapy for pregnant women living with HIV or hepatitis B: a systematic review and meta-analysis. BMJ Open 207;7:e019022.

4. Peer review of Siemieniuk RA, Foroutan F, Mirza R et al. Antiretroviral therapy for pregnant women living with HIV or hepatitis B: a systematic review and meta-analysis. BMJ Open 207;7:e019022. Available at: http://bmjopen.bmj.com/content/bmjopen/7/9/e019022.reviewer-comments.pdf Accessed October 9, 2017.

5. World Health Organization. “Maternal and perinatal health.” http://www.who.int/maternal_child_adolescent/topics/maternal/maternal_pe... Accessed October 9, 2017.

6. Zash R, Jacobson DL, Diseko M, et al. Comparative Safety of Antiretroviral Treatment Regimens in Pregnancy. JAMA Pediatr. 2017 Oct 2;171(10):e172222.

7. Agoritsas T, Merglen A, Shah ND, O'Donnell M, Guyatt GH. Adjusted Analyses in Studies Addressing Therapy and Harm: Users' Guides to the Medical Literature. JAMA. 2017 Feb 21;317(7):748-759.

8. Lytvyn L, Siemieniuk RA, Dilmitis S, et al. Values and preferences of women living with HIV who are pregnant, postpartum or considering pregnancy on choice of antiretroviral therapy during pregnancy. BMJ Open. 2017 Sep 11;7(9):e019023.

9. Welbourn, A. WHO and the rights of women living with HIV. BMJ Opinion. Available at: http://blogs.bmj.com/bmj/2017/09/11/alice-welbourn-who-and-the-rights-of... Accessed October 9, 2017.

Competing interests: No competing interests

10 October 2017
Reed A.C. Siemieniuk
Physician
Graham P. Taylor, Gordon H. Guyatt, Lyubov Lytvyn, Yaping Chang, Paul E. Alexander, Yung Lee, Thomas Agoritsas, Arnaud Merglen, Haresh Kirpalani, Susan Bewley
McMaster University
1280 Main St West, Hamilton, ON, Canada