HIV treatment during pregnancy

Starting HIV treatment during pregnancy may increase the risk of having a pre-term delivery, a small baby and stillbirth, a study conducted in Botswana shows.

Researchers looked at the outcomes of pregnancy for 33,000 women, making this the largest-ever study examining the safety of HIV treatment during pregnancy.

With the right treatment and care, the risk of mother-to-child transmission of HIV can be reduced to below 1%.

There is conflicting information about the safety of treatment during pregnancy. Some research has shown that taking treatment during pregnancy, especially if the combination includes a protease inhibitor, increases the risk of premature delivery or having a small baby.

Researchers wanted to get a clearer understanding of the risks.

Combination HIV treatment (usually a combination of three drugs) during pregnancy is recommended for women who need it for their own health – for instance if their CD4 cell count is below 350 or if they are ill because of HIV. Otherwise, in the UK, women are advised to start treatment during their pregnancy (by week 24 at the latest). Women who don’t need HIV treatment for their own health have the option of treatment with AZT (zidovudine) alone.

The researchers found that taking combination treatment increased the risk of adverse birth outcomes by between 40 and 80%. Taking AZT monotherapy was also associated with an increased risk of complications, but to a lesser degree.

However, the researchers stress that caution is needed when interpreting their results. For instance, many of the women were ill with malaria or tuberculosis (TB), and this is likely to have affected birth outcomes.

They also say that premature delivery or low birth weight doesn’t necessarily result in longer-term problems, particularly in countries with the resources to care for these babies.

It’s important to stress that the benefits of treatment to prevent mother-to-child transmission more than compensate for the possible risks. HIV-positive pregnant women in the UK receive care from a number of different specialists to look after their own health and that of their baby. You can find out more about treatment during pregnancy in NAM’s booklet HIV and women.

HIV and liver cancer

There has been a significant increase in cases of liver cancer among people with HIV, according to recent Spanish research.

All the cases were in people co-infected with hepatitis B or hepatitis C virus.

Liver disease is an increasingly important cause of serious illness and death in people with HIV, especially in those who have hepatitis co-infection.

Researchers in Spain wanted to see if rates of hepatocellular carcinoma (HCC, the most common liver cancer in people with hepatitis C) were increasing in people with HIV. They looked at the records of patients who received care at 18 separate clinics between 1999 and 2010.

A total of 82 cases of liver cancer were identified. All involved people co-infected with viral hepatitis, and most of the cases (66, or 81%) were in people co-infected with hepatitis C.

Almost all the patients had liver cirrhosis (permanent scarring) at the time liver cancer was diagnosed.

Only a third of people had their cancer detected during routine care, and just 29% of people co-infected with hepatitis C had received appropriate antiviral treatment.

Outcomes were poor – 79% of the people identified died. However, survival rates were better for people who had a liver transplant or other liver surgery.

The researchers think that the increase in cancer rates has a number of causes. For example, improvements in HIV care mean that people co-infected with viral hepatitis are living long enough for liver cancer to develop. Also, treatment for hepatitis C doesn’t always work in co-infected people.

The findings of this study have a number of implications. They show the importance of monitoring co-infected people with liver damage for signs of cancer.

The research also shows the importance of treating hepatitis C – and this was underlined by the findings of a separate study, explained below.

Hepatitis C treatment reduces risk of liver cancer

An analysis of the results of several studies has shown that antiviral treatment reduces the risk of liver cancer in people with hepatitis C who have liver fibrosis or cirrhosis.

A total of eight randomised trials and five observational studies were included in the analysis. The people included in the study had hepatitis C mono-infection.

Overall, the results of this study showed that antiviral treatment reduced the risk of liver cancer by 47%.

The risk was reduced by 85% when treatment achieved a sustained virological response (SVR, an undetectable hepatitis C viral load six months after the completion of treatment, which is considered a cure).

But treatment that didn’t achieve a cure also had benefits, reducing the risk of liver cancer by 43%.

Only a small minority of people were taking the current standard of hepatitis C therapy – pegylated interferon and ribavirin. Most were taking interferon mono-therapy.

The researchers believe their results show that interferon drugs don’t just have antiviral properties, but may also inhibit the development of cancer.