This Week in HIV Research: Pregnancy Findings That Aren't About Dolutegravir

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While the big recent headlines in research regarding HIV and pregnancy have centered on the safety of dolutegravir (Tivicay), a number of new studies have advanced our knowledge in other areas. Most of the studies we've selected for this week's exploration highlight some of those not-just-about-dolutegravir pregnancy subjects. On tap in today's research run-through:

  • Prior concerns regarding raltegravir (Isentress) use in pregnancy were overinflated, similar to prior concerns regarding dolutegravir use.
  • There may be a relationship between a pregnant woman's comfort with disclosing her HIV status and her likelihood of achieving viral suppression.
  • Any reductions in body size among newborns exposed to HIV appear to vanish within 18 months.
  • Problems with hearing among people living with HIV (PLWH) appear to be related to the virus itself rather than the medications used to treat it.

Let's move in for a more detailed look. To beat HIV, you have to follow the science!

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Raltegravir Appears Safe Before and During Pregnancy

Taking raltegravir around pregnancy is not associated with neural tube defects (NTDs) in the baby, an analysis of data from the manufacturer’s safety database that was published in Journal of Acquired Immune Deficiency Syndrome found.

Last year, a warning was issued for a similar integrase inhibitor, dolutegravir, raising concern that raltegravir may also cause NTDs. The current study’s authors analyzed data on 2,426 pregnancies, finding three infants with neural tube defects. In the general population, the estimated NTD rate is 19 per 10,000 births.

Most reports came from Europe and the U.S., while the initial concern was raised in Botswana, where folate supplementation, which is recommended to prevent NTDs, is uncommon. Study results were originally presented in March at the CROI 2019 conference in Seattle and are reiterated in the current report.

Meanwhile, at the IAS 2019 conference in Mexico City in late July, researchers retracted the dolutegravir warning, causing the World Health Organization to revise its recommendations. The upshot: Expert guidance is now that there is no reason to deny access to dolutegravir or raltegravir for women who are, or want to become, pregnant

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HIV Disclosure Tenuously Linked to Viral Suppression in Pregnant Women

Is there a relationship between a pregnant woman's decision to disclose her HIV status and her odds of achieving viral suppression? Conditionally yes, according to a study published in the Journal of Acquired Immune Deficiency Syndromes.

Researchers gathered data on 1,187 pregnant women living with HIV in Cape Town, South Africa. The association between detectable viral load (≥ 50 copies/mL) and disclosure depended on three factors:

  • Whether the woman learned her HIV status before or during pregnancy.
  • Whether she was married to or cohabiting with a male partner to whom she disclosed her HIV status.
  • What relationship she had to any other person to whom she disclosed.

Disclosure made no difference in viral suppression for women who already knew that they were living with HIV when they became pregnant. Among those who were diagnosed during pregnancy, disclosure to a family or community member was associated with viral suppression 12 months after giving birth, and disclosure to a live-in male partner was related to viral suppression at delivery, especially when the woman told her partner about the diagnosis soon after receiving it. "Counseling about disclosure may be most effective if tailored to individual women's circumstances," study authors concluded.

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Infants Exposed to HIV Smaller at Birth, But Catch Up Quickly

Children who are exposed to HIV, but not living with the virus, are smaller at birth than a matched set of unexposed children, but the difference diminishes with age, a Danish study published in Clinical Infectious Diseases found.

Researchers compared weight and length for age, as well as weight for length/body mass index (BMI) for age scores from 485 children exposed to HIV and 2,495 controls, all of whom were followed to age 5. Data came from a national registry that includes all children born in the country during the study period. The size difference seen at birth disappeared by 18 months of age.

The observed difference in BMI may be related to formula feeding of infants born to women living with HIV, in keeping with World Health Organization recommendations for high-resource settings, study authors noted. They raised a concern that the faster growth HIV-exposed babies seem to undergo during their first year of life may predispose them to a greater risk of obesity and other disorders later in life.

Study authors called for more data on long-term health implications for children exposed to HIV in utero but born HIV negative.

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Hearing Difficulties in PLWH Related to Central Nervous System

Antiretrovirals do not affect hearing in people living with HIV. Rather, auditory problems may be related to the virus's effect on the central auditory processing system, a small study published in AIDS showed.

Researchers analyzed data from repeated hearing tests among 391 people living with HIV -- 107 of whom started treatment during the study period -- and 72 HIV-negative controls in Tanzania. Three tests were conducted (not all of which were completed by everyone): audiometry, distortion-product otoacoustic emissions, and gap detection threshold.

The threshold in the last test increased independent of HIV treatment initiation, suggesting problems in the central nervous system (CNS) rather than the ear. While the distortion-product test indicated worsening of outer hair cell function in the ear over time, this change did not differ significantly from that in the HIV-negative group. Part of the observed differences in that test may stem from difficulties in administering it, study authors noted.

Other research undertaken in China indicates that difficulties in understanding speech against background noise correlate with cognitive function in PLWH. These study results show that problems with central auditory tasks in PLWH are likely related to CNS dysfunction rather than the effects of antiretroviral therapy, the authors concluded.