{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T01:37:33Z","timestamp":1770514653433,"version":"3.49.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,6,5]],"date-time":"2015-06-05T00:00:00Z","timestamp":1433462400000},"content-version":"vor","delay-in-days":155,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"name":"CMIS"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The risk of pre\u2010term birth (PTB) associated with the use of protease inhibitors (PIs) during pregnancy remains a subject of debate. Recent data suggest that ritonavir boosting of PIs may play a specific role in the initiation of PTB, through an effect on the maternal\u2013fetal adrenal axis. The primary objective of this study is to compare the risk of PTB among women treated with boosted PI versus non\u2010boosted PIs during pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 1988 and 2011, 705 HIV\u2010positive women were enrolled into the Centre Maternel et Infantile sur le SIDA mother\u2013infant cohort at Centre Hospitalier Universitaire Sainte\u2010Justine in Montreal, Canada. Inclusion criteria for the study were: 1) attendance at a minimum of two antenatal obstetric visits and 2) singleton live birth, at 24 weeks gestational or older. The association between PTB (defined as delivery at &lt;37 weeks gestational age), antiretroviral drug exposure and maternal risk factors was assessed retrospectively using logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 525 mother\u2013infant pairs were included in the analysis. Among them, PI\u2010based combination anti\u2010retroviral therapy was used in 37.4%, boosted PI based in 24.4%, non\u2010nucleoside reverse transcriptase inhibitor (NNRTI) or nucleoside reverse transcriptase inhibitor based in 28.1%, and no treatment was given in 10.0% of cases. Overall, 13.5% of women experienced PTB. Among women treated with antiretroviral therapy, the risk of PTB was significantly higher among women who received boosted versus non\u2010boosted PI (OR 2.01, 95% CI 1.02\u20133.97). This remained significant after adjusting for maternal age, delivery CD4 count, hepatitis C co\u2010infection, history of previous PTB, and parity (aOR 2.17, 95% CI 1.05\u20134.51). There was no increased risk of PTB with the use of unboosted PIs as compared to NNRTI\u2010 or NRTI\u2010based regimens.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>While previous studies on the association between PTB and PI use have generally considered all PIs the same, our results would indicate a possible role of ritonavir boosting as a risk factor for PTB. Further work is needed to understand the pathophysiologic mechanisms involved, and to identify the safest ARV regimens to be used in pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.7448\/ias.18.1.19933","type":"journal-article","created":{"date-parts":[[2015,6,5]],"date-time":"2015-06-05T08:31:49Z","timestamp":1433493109000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Risk factors for pre\u2010term birth in a Canadian cohort of HIV\u2010positive women: role of ritonavir boosting?"],"prefix":"10.1002","volume":"18","author":[{"given":"Fatima","family":"Kakkar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Boucoiran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Lamarre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thierry","family":"Ducruet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devendra","family":"Amre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo","family":"Soudeyns","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Normand","family":"Lapointe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Boucher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,6,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200012220-00013"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200411190-00019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328133884b"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2008.00520.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000139398.38236.4d"},{"issue":"1","key":"e_1_2_8_7_1","first-page":"51","article-title":"Combination antiretroviral therapy with protease inhibitors in HIV\u2010infected pregnancy","volume":"40","author":"Dola CP","year":"2011","journal-title":"J Perinat Med"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/651232"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1086\/503045"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jis728"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32802ef2f6"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-14-42"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2008.032300"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/507045"},{"key":"e_1_2_8_15_1","unstructured":"Panel on Treatment of HIV\u2010Infected Pregnant Women and Prevention of Perinatal Transmission.Recommendations for use of antiretroviral drugs in pregnant HIV\u20101\u2010infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States.2012[cited 2013 Aug 22]. 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