The impact of antiretroviral therapy used in pregnancy on the health of HIV-positive women

In the UK, antiretroviral therapy (ART) is used during the vast majority of pregnancies among women living with HIV. This thesis aims to examine some of the consequences of antenatal ART use on women's health during and after pregnancy. Initially, a linkage was developed between two well established studies, the UK Collaborative HIV Cohort (UK CHIC) Study and the UK and Ireland's National Study of HIV in Pregnancy and Childhood (NSHPC). The resultant dataset was used to assess pregnancy incidence in women attending HIV clinical care at UK CHIC sites in 2000- 2009. The overall pregnancy incidence increased. The rate of increase did not significantly differ between ethnic groups, age groups or according to ART use. In women starting life-long cART at least one year after HIV diagnosis, those who had previously used short-course cART in pregnancy were more likely to experience viral rebound and interrupt their treatment compared to those who had never previously used ART. Levels of the liver enzyme alanine transaminase (ALT) were assessed in women on combination ART (cART). The risk of liver enzyme elevation (LEE) was higher during pregnancy than at other times in women who started ART during pregnancy and in women who conceived on ART. The risk of viral rebound (HIV-RNA >200 copies/ml) whilst on cART was higher in women who had recently had a pregnancy than in similar women who had not recently been pregnant. In post-pregnant women remaining on cART, the risk of viral rebound was higher in women who had started cART during their pregnancy than in women who had conceived on cART. The findings presented in this thesis contribute to the evidence-base for the management of pregnant women living with HIV and highlight the need for close monitoring of toxicity in pregnancy and additional drug adherence support following pregnancy.