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Infectious Diseases

Poster Session 2

(478) Bictegravir Use During Pregnancy: A Multi-Center Retrospective Analysis Evaluating HIV Viral Suppression and Perinatal Outcomes

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Integrase strand-transfer inhibitors (INSTI) are recommended as part of antiretroviral therapy for most people with HIV. Bictegravir (BIC) is a first line INSTI in non pregnant adults living with HIV, however there is a paucity of data on its use in pregnancy. The objective of this study was to describe maternal viral suppression and perinatal outcomes among people with HIV who used BIC during pregnancy.    

Study Design: We performed a multi center retrospective cohort study of pregnant people with HIV who used a BIC containing antiretroviral regimen between January 2019- June 2023 at 4 different centers in the United States. Demographics, HIV, perinatal, and infant outcomes were abstracted from the medical record and summarized by timing of BIC use in pregnancy. Viral suppression was defined as HIV-1 RNA (viral load) < 50 copies/mL

Results: 147 pregnancies with BIC use were included in the analysis (Site 1 [n=41], Site 2 [n=18], Site 3 [n=75], Site 4 [n=13]). The median age was 29 (range 16-43) years, and the median gestational age of delivery was 39 (range 26-41) weeks. Of these pregnancies, 83 (56.4%) received BIC preconception and continued in pregnancy, 59 (40.1%), started BIC during pregnancy and 5 (3.4%) received BIC preconception and discontinued during pregnancy. Viral suppression closest to delivery was highest in those receiving BIC preconception and continued in pregnancy (96.2%), and no cesarean deliveries for elevated HIV viral load occurred in this group. For those who started BIC prior to conception and continued on it through pregnancy, a birth defect was noted in 2.4%. One perinatal HIV transmission occurred after a third trimester HIV diagnosis with BIC started at 31 weeks' gestation.

Conclusion: In this analysis, the use of BIC in pregnancy was associated with high levels of viral suppression and similar perinatal outcomes to published literature in this patient population. These findings highlight the potential efficacy and safety of BIC in pregnancy and support its consideration in the management of HIV during pregnancy.