Metabolic implications and safety of dolutegravir use in pregnancy

Dontsova, Valeriya; Mohan, Haneesha; Blanco, Carlos E.; Jao, Jennifer; Greene, Nicholas D. E.; Copp, Andrew J.; Zash, Rebecca; Serghides, Lena

doi:10.1016/s2352-3018(23)00141-8

Cited by 4 publications

(1 citation statement)

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“…The impact of integrase inhibitors on weight gain has been demonstrated, suggesting that pregnant women under treatment with this type of drug have an increased risk of developing metabolic complications, including weight gain and rare events of hyperglycemia, in particular those women who start the pregnancy with a BMI > 25 kg/m 2 . There is little evidence about their progeny; some of them present a rate of newborns that are small for gestational age (SGA) of 15% higher than that expected for the general population, and other publications only infer that the metabolic effects demonstrated in the pregnant woman could also be manifested in the fetus, but this has not been confirmed [ 22 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Protease Inhibitor-Based Highly Active Antiretroviral Therapy on Fetal Subcutaneous Fat Tissue in HIV-Pregnant Women in a Middle-Income Country

Borboa-Olivares,

Estrada-Gutierrez,

Martinez-Portilla

et al. 2023

Viruses

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Background: HIV infection continues to be a global public health challenge, affecting approximately 1.7 million reproductive-aged women. Protease inhibitor-based highly active antiretroviral therapy (PI-HAART) has significantly reduced the risk of vertical transmission of HIV from mother to child. Nevertheless, concerns linger regarding the long-term effects, particularly on body composition, notably subcutaneous fat tissue (SFT). Although HIV-associated lipodystrophy syndrome (LS) has been well documented in adults and older children, its impact on fetuses exposed to PI-HAART remains underexplored. This study aims to evaluate SFT in the fetuses of HIV-pregnant women exposed to PI-HAART, assessing the potential clinical implications. Methods: We conducted a comparative study between HIV-pregnant women receiving PI-HAART and an HIV-negative control group. Fetometry measurements were obtained via 3D ultrasound. SFT in the fetal arm and thigh segments was assessed. Data were analyzed using lineal multivariate regression and receiver-operating characteristics (ROC)-curve analysis. Results: Fetuses exposed to PI-HAART exhibited a significant reduction in subcutaneous fat, particularly in the proximal third-middle union of the femur (coefficient: −2.588, p = 0.042). This reduction was correlated with lower newborn serum glucose levels (65.7 vs. 56.1, p = 0.007; coefficient: −1.277, p = 0.045). Conclusions: Our study sheds light on the connection between PI-HAART, fetal subcutaneous fat, and neonatal health. These findings might reveal the long-lasting effects of PI-HAART on newborns and children’s well-being. Our results emphasize the need for a more balanced approach to managing pregnant women with HIV in developing countries and open new venues for research on the impact of intrauterine PI-HAART exposure on energy metabolism and fetal programming.

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Section: Discussionmentioning

confidence: 99%