Experience with Invirase as part of triple therapy as the drug of choice in the perinatal prevention of HIV transmission in the Ulyanovsk Region

AIM: To retrospectively analyze the efficacy and safety of ritonavir-boosted saquinavir (SQV) in the perinatal prevention of HIV infection in pregnant women in the Ulyanovsk Region. Materials and methods. The outpatient cards of HIV-positive pregnant women who received ritonavir-boosted SQV in a dose of 1000/100 mg bid in combination with zidovudine or stavudine and lamivudine for the perinatal prevention of HIV infection in 2010-2011 were retrospectively analyzed. The main efficiency criterion was a proportion of children taken off a regular medical check-up in terms of perinatal contact as healthy at 18 months post-birth. The additional criteria (end points) were changes in viral load and CD4 cell count at 4 and 8-12 weeks after initiation of prevention/RESULTS: The analysis included data on 98 HIV-positive pregnant women. The history of HIV infection was 3 years or less in 63.2% of the patients. Stage 3 and 4A HIV infection was stated in 87 and 13% of the women, respectively. Treatment with ritonavir-boosted SQV + 2 nucleotide reverse transcriptase inhibitors was started in 84.8% of the women at 15-28 weeks' gestation and in 12.2% of cases in earlier periods. Four weeks after initiation of highly active antiretroviral therapy, the viral load showed a 1-4 log10 decrease. By that time and at 8-12 weeks, it was undetectable (<500 copies/ml) in 75 (76.5%) and 82 (83.6%) women, respectively. With a decrease in the viral load, CD4 cell count increased by 100-500 per mm3 (mean 160 per mm3). The efficiency of prevention of perinatal HIV transmission was 100%. No serious adverse events were observed/CONCLUSION: The use of ritonavir-boosted SQV in combination with two nucleotide reverse transcriptase inhibitors is an effective and safe chemoprevention regimen for perinatal HIV transmission in pregnant women.

HIV infection, pregnant women, perinatal transmission, perinatal prevention of HIV infection, protease inhibitors, ritonavir-boosted SQV, SQV