Question special

Congratulations to the authors on an extremely important study--as others have mentioned, it reminds us how important it is to continue research to determine the safest ART for pregnancy and figure out the mechanisms of adverse outcomes among HIV-infected women. Also, this study highlights that we need to consider the effect of both individual ARV drugs as well as combinations of drugs and dosing. I am involved in similar research on the safety of ART in pregnancy in Botswana. Often, when I present my results locally (in Boston), many in the audience will feel that the results are not necessarily generalizable to the US--and that results will be different in resource-poor and resource-rich settings. Although your study sites were not in the US or Europe, I suspect there were economic/obstetric care differences between the sites. Did you find any differences in effect by site? Do you think your results are generalizable to other settings?