Pregnancy outcomes in women exposed to efavirenz and nevirapine: an appraisal of the IeDEA West Africa and ANRS Databases, Abidjan, Cote d'Ivoire

BACKGROUND An increasing number of HIV-infected women become pregnant while receiving efavirenz (EFV). We compared the pregnancy outcomes of women exposed to EFV and to nevirapine (NVP) during the first trimester. METHODS A retrospective study in 4 HIV care centers participating to clinical trials and international cohort collaboration. All HIV-infected pregnant women who conceived on EFV-based or NVP-based antiretroviral therapy (ART) between 2003 and 2009 were included. Pregnancy outcomes were as follows: abortion (voluntary termination), miscarriage [unwanted termination 20 weeks of amenorrhea (WA)], stillborn (death ≥ 20 WA), preterm delivery (live-birth 37 WA), and low birth weight (LBW) (2500 grams). RESULTS Overall, 344 HIV-infected pregnant women conceived on ART (213 on EFV and 131 on NVP). Median age was 29 years, and median CD4 count 217 cells per microliter at ART initiation. The overall proportion was 11.7\% for abortion, 5.2\% for miscarriage, 6.7\% for stillborn, 10.8\% for preterm delivery, and 20.2\% for LBW. There was no difference between EFV and NVP exposure, except for abortion (14.3\% vs 7.3\%; P = 0.05). No external and visible congenital malformation was observed neither in women exposed to EFV nor in women exposed to NVP. CONCLUSIONS Among women exposed to EFV, no significant increased risk of unfavorable pregnancy outcome was reported except for abortion.