The use of HAART in pregnancy has shown remarkable improvement in immune status and reduction of MTCT of HIV infection [1] but some adverse pregnancy conditions have been seen in some studies [2, 3, 4]. These include preterm delivery, low birth weight and gestational diabetes. Although, some adverse effects on pregnancy outcome have been observed, the results from various studies are conflicting; which certainly depend on regimen, year at which the regimen was used, setting and country- hence their clinical significance is uncertain.
As the dynamic progressive changes in the use of ARVs and the evolution of HIV treatment regimen was not adapted at the same pace by various settings, country and practice. These variations in the literature and conflicts of research evidence may continue but a systematic robust evidence in the future may objectively resolve conflicts and issue statement on clinical significance.
However, in some studies the use of HAART may or may not have played a causative role. The European cohort studies had consistently demonstrated an increased risk of preterm delivery associated with HAART [3, 4, 5, 6] although this has been related to ARV regimen. In the study by Cotter et al [3] the preterm delivery was reported among those who had protease inhibitor (PI) in the ARV combination (HAART) and not in regimen without PI.
A South African study had inconclusive evidence regarding the association of preterm delivery and low birth weight to HAART [7]. A multicenter study conducted in Botswana [8] observed an increased risk of preterm delivery, small for gestation age (SGA) infants, Stillbirths, and neonatal deaths among pregnant women exposed to HAART.
Outside pregnancy, HAART regimens have been associated with a range of metabolic complications, including glucose intolerance, type-2 diabetes mellitus and dyslipidemia. However, in pregnancy, cohort studies investigating the association of HAART with gestational diabetes have yielded conflicting results [9].
The Gambia had transition from prophylactic use of ARV drug combination in 2011 where by the drugs were used from 14 weeks of gestation and discontinue after delivery which was named option A by WHO (10). But in 2015 during the time of this study ARVs was used for extended periods after delivery and during breastfeeding and subsequently for life. However, the transition of the ARV drugs regimen did not occur automatically as some patients continue in the older regimen and some in the new regimen of TDF/3TC/EFV- a single dose taking once a day.
Remarkably, those patients that had seropositivity for type 2 and dual infection (Type 1 and 2) continued in their primary regimen as evidence have shown (11) that sero status of HIV − 2 was insensitive to non-nucleotide reverse transcriptase inhibitors (e.g. EFV and NVP). Hence they continue on their ARV combination that has protease inhibitors (e.g LPVr). In view of these challenges since that time, scientific evidence and programmatic experience have accumulated on the use of dolutegravir (DTG) in both first- and second-line ART, including during pregnancy and tuberculosis co-treatment, and for children.
In 2018, these guidelines were reviewed to provide updated guidance on preferred option for these populations which now include dolutegravir (DTG) and raltegravir (RAL) (11). These new frontiers of ARVs were not in this study as country adaptation occur at varied pace, is a research interest of the future in our setting.
In view of the above explanation there was need to assess the impact of these diverge ARV combinations and regimen on different HIV strain sero- positivity among HIV positive pregnant mothers in our practice.