McDonald CR, et al. - Herein, researchers probed into the longitudinal progesterone and estradiol levels in pregnancy using specimens from the Protease Inhibitors to Reduce Malaria Morbidity in HIV-infected Pregnant Women study, comprising of Ugandan human immunodeficiency virus (HIV)–infected antiretroviral therapy (ART)-naive women recieving either lopinavir/ritonavir (LPV/r)–based or efavirenz (EFV)–based combination antiretroviral therapy (cART). It was noted that the cART regimens exerted a differential impact on the estradiol levels (critical for the maintenance of a healthy pregnancy) during pregnancy. It was deduced that the detection of cART regimens which minimized perinatal HIV transmission without contributing to hormonal dysregulation served as an urgent public health priority.

Methods

• The recruitment comprised of 326 women (160 randomized to the EFV arm and 166 women to the LPV/r arm) with at least 1 plasma sample collected during pregnancy.
• During this trial, samples collected prior to cART initiation were used as a cART-naive comparator group.
• With the aid of enzyme-linked immunosorbent assay, experts quantified the hormone levels.

Results

• Estradiol levels exhibited a differential affection through the 2 cART regimens.
• A correlation was disclosed between exposure to LPV/r with an increase in estradiol (P < .0001).
• In contrast, exposure to EFV illustrated a link with decrease in estradiol (P < .0001), relative to the cART-naive gestationally matched comparator group.
• Findings demonstrated that lower estradiol levels were associated with small for gestational age (SGA) (P=.0019) and low birth weight (P=.019) in the EFV arm.
• On the other hand, a relation was found between higher estradiol levels with SGA in the LPV/r arm (P=.027).
• Despite the presence of similar progesterone levels between treatment arms, a correlation was displayed between SGA and lower progesterone in the LPV/r arm (P=.04).
• Researchers did not discover any link between hormone levels and preterm birth in either arm.
• Data exhibited lower levels of progesterone and estradiol in cases of stillbirth.
• A decline was reported in the levels of both hormones immediately prior to stillbirth in 5 of 8 cases.