Previous studies have found that the use of ART for HIV during pregnancy can be associated with hormonal dysregulation. The authors performed a secondary retrospective analysis of the longitudinal progesterone and oestradiol levels measured during pregnancy from women in the Protease Inhibitors to Reduce Malaria Morbidity in HIV-infected Pregnant Women study, which randomised Ugandan HIV-infected ART-naive women to initiate either lopinavir/ritonavir (LPV/r)-based or efavirenz (EFV)-based ART. 326 women (160 EFV arm and 166 LPV/r arm) had at least one plasma sample collected during pregnancy. The authors found that oestradiol levels were differentially affected by the two ART regimens. Exposure to LPV/r was associated with a significant increase in oestradiol, while exposure to EFV was associated with a significant decrease in oestradiol (P < .0001). Lower oestradiol levels correlated with small for gestational age (SGA) and low birth weight in the EFV arm, while higher oestradiol levels only correlated with SGA in the LPV/r arm. Although the progesterone levels were similar between the treatment arms, there was an association between SGA and lower progesterone levels in the LPV/r arm. No significant association was seen between hormone levels and preterm birth in either arm. Levels of progesterone and oestradiol were found to be lower in cases of stillbirth and levels of both hormones declined immediately prior to stillbirth in five out of the eight cases. Therefore ART regimens differentially affect oestradiol levels duing pregnancy.
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