HIV DRUG COMBO MAY BE RISKY IN EARLY PREGNANCY
Reuters 26 Dec. 2001
HIV-infected women who take certain combinations of medications in
their first trimester of pregnancy may increase the risk of having a
child with birth defects, a small study suggests.
In particular, women who took a drug to ward off Pneumocystis carinii
pneumonia (PCP)--a common and often life-threatening infection seen
in AIDS patients--in combination with antiretroviral drugs early in
pregnancy were more likely to have a baby with birth defects.
However, taking either type of drug alone in early pregnancy did not
seem to be a problem. And taking antiretroviral drugs later in
pregnancy is known to dramatically decrease the chances that a mother
will pass HIV to her baby. Worldwide surveillance to date has shown
no excess risk of birth defects in infants exposed to such drugs
The finding is reported in the December issue of the journal Sexually
In the study, Dr. Graham Taylor from Imperial College in London, UK
and colleagues evaluated the risk of birth defects in infants of 195
Overall, nine children (4.6%) were born with abnormalities, the
authors report. None of the 34 infants exposed to either
antiretroviral drugs alone or PCP-preventing drugs alone during the
first trimester had birth defects. In contrast, three of 13 (23.1%)
children exposed to both therapies had birth defects, the report
"Although the numbers are small, they had a sevenfold increased risk
of birth defects compared with infants not exposed to any drugs
during the first trimester," the authors write.
"These findings, if confirmed, have important implications for
preconceptual counseling and the therapeutic choices of women of
childbearing age," they conclude.
Taylor told Reuters Health that physicians should take care "to
regularly review the needs of therapy before women become pregnant
and to ensure that women with HIV who wish to become pregnant,
especially those who need to take PCP prophylaxis, take folic acid
Drugs used to combat PCP are known as folate antagonists, meaning
they deplete folate--the form of folic acid found in the blood--in the
body. Folic acid has been found to help prevent birth defects when
taken by women before and during early pregnancy.
The findings "suggest that the need for PCP prophylaxis should be
regularly reviewed in all women of child-bearing potential," Taylor
Source: Sexually Transmitted Infections 2001;77:441-443.