Antiretroviral Prescribing in Pregnancy Strays From National Guidelines

For pregnant women with HIV, antiretroviral medication (ARV) prescribing practices do not align well with national guidelines, according to a study published online in JAMA Network Open.

Kathleen M. Powis, M.D., M.P.H., from Massachusetts General Hospital in Boston, and colleagues compared antiretroviral prescribing practices over time among pregnant women living with HIV to U.S. Department of Health and Human Services treatment guidelines. The retrospective cohort study included 1,582 pregnant women living with HIV with 1,867 pregnancies.

The researchers found that ARVs were initiated prior to conception, resumed during pregnancy, and initiated during pregnancy for 42.3, 33.5, and 24.2 percent of women, respectively. During the pregnancies, 49.5, 26.4, and 7.3 percent were prescribed an ARV designated as preferred or alternative, an ARV with insufficient evidence for use during pregnancy, or an ARV not recommended for use during pregnancy, respectively. Treatment-naive pregnant women initiating ARVs were prescribed preferred or alternative ARVs more often (69.9 percent) compared with those resuming ARVs or treated with ARVs before conception (52.0 and 35.9 percent, respectively; P < 0.001). Overall, 20.1 percent of women initiating ARVs during pregnancy were prescribed ARVs with insufficient evidence for use during pregnancy or ARVs not recommended during pregnancy.

"Our study demonstrates discordance between guideline recommendations and actual prescribing practices, even when prescribing for treatment-naive pregnant women living with HIV," the authors write.

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