Date of Award

7-1-2003

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Warren A. Andiman MD

Second Advisor

Howard Pearson MD

Abstract

We investigated patterns of efavirenz use among physicians caring for HIV-positive women in the primary HIV and high-risk obstetrics clinics (HROC) of an academic teaching hospital. Efavirenz, a non-nucleoside reverse transcriptase inhibitor approved for HIV treatment, is a potential teratogen. The FDA recommends that women prescribed efavirenz use two forms of birth control and avoid becoming pregnant. We conducted a retrospective analysis of medical records of reproductive-age HIV-positive women seen between September 1998 and December 2002, recording information documented at initial prescription of efavirenz, pregnancies occurring on efavirenz, other antiretroviral medications taken during pregnancy, and fetal malformations noted at birth. We administered a quiz regarding efavirenzs side effects to the HIV clinic providers. Four hundred fifty-six reproductive-age HIV-positive women were treated in the adult (N=442) and pediatric (N=14) clinics. Ninety-nine adult (22.4%) and 3 pediatric (21.4%) reproductive-age women were prescribed efavirenz. At efavirenzs initial prescription, 21.3% and 33.3% of medical records mentioned efavirenzs side effects, 3.8% and 0.0% documented birth control method, and 0.0% and 0.0% documented mention of teratogenicity or pregnancy test, respectively. Four percent of adult efavirenz-takers became pregnant while on efavirenz. Fifty-seven pregnancies were managed at the HROC; 98.2% resulted in live births and 1.8% resulted in intrauterine fetal demise. 7.3% of these women took efavirenz during pregnancy, one of which resulted in intrauterine fetal demise, one in pre-term delivery, and two in uncomplicated births. Another pregnant efavirenz-taker suffered intrauterine fetal demise before her first visit to the HROC. Eighty-seven percent of the adult HIV clinic providers participated in the quiz; of these, 50% knew efavirenz was potentially teratogenic, 100% noted communicating medication side effects at initial prescription, and 45% noted documenting this discussion in the medical record. We found strong evidence that HIV-positive women are at risk of exposing their fetuses to efavirenzs potentially teratogenic effects.

Comments

This is an Open Access Thesis.

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