Background:
Before anti retroviral therapy (ART), 15 – 25% of the children of HIV-positive mothers
in Europe perinatally got infected with HIV. ART reduced perinatal transmission to
< 1%. German and Austrian guidelines for HIV therapy during pregnancy recommend the
combination of two nucleotide reverse transcriptase inhibitors (NRTI) with a boostered
protease inhibitor (PI) or a non-nucleotide transcriptase inhibitor (NNRTI). Integrase
inhibitors can be used for fast reduction of the viral load in the third trimester.
Case report:
A 27-year old patient with HIV-infection, IIG/0P, 31+5 pregnancy weeks, presented
in our outpatient clinic for infectious diseases. The infection was detected three
months prior to initial presentation. She got started on ART according to the Guidelines
(Truvada 1 – 0-0 and Isentress 1 – 0-1). Initial viral load: 312 000 cop/ml. The subsequent
viral load after ART-induction was similar. The patient felt nauseated by the medication,
which led to incompliance. A different regime was initiated, but the following viral
load was still six-figured, indicating incompliance again. The repeated incompliance
regarding multi-pill ART led to the decision to get the patient started on a single-pill-regime,
Symtuza (Darunavir, PI, Tenofoviralafenamid, NtRTI, Emtricitabin, NRTI, and Cobicistat,
not licensed during pregnancy). The patient stayed compliant under Symtuza, the following
viral load being 870 cop/ml. We currently await the new viral load, determining her
birth mode.
Conclusion:
Most ART agents aren't licensed during pregnancy. The license for use during pregnancy
shouldn't be the main criteria in choosing ART, since reducing the viral load is the
main factor in reducing the transmission risk.
