Single-Pill ART-therapy may improve compliance to ART in pregnant women with HIV-infection: a case report

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.