Use of Raltegravir in HIV-Infected Pregnant Women: A Case Series and Review of the Literature

Objective: To evaluate the safety and tolerability of RAL therapy and the rapidity with which RAL decreases viral load in HIV-infected pregnant women. Methods: Women were considered for inclusion in the study if they were HIV-seropositive, ≥18 years of age, and received RAL during pregnancy. HIV viral load, CD4 count (absolute), pregnancy demographics, antiretroviral regimens, adverse events, liver function enzymes, and APGAR scores were collected. Results: Eight HIV-infected RAL-naïve pregnant women presented between 6 to 39.4 weeks gestational age with a median RNA viral load of 41,083 copies/mL at the initiation of RAL. From the initiation of RAL until delivery, the median decline in RNA viral load was 1.60 log. At delivery, two patients reached <48 copies/mL and two had <500 copies/mL. The median RNA viral load at delivery was 911 copies/mL. No adverse events in the mother or neonate due to RAL therapy were noted during this study. Conclusions: These results support the safe and efficacious addition of RAL to HAART regimen to decrease RNA viral load late in pregnancy if a patient is not yet virologically suppressed. Further prospective study is needed.