Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate-Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum
Issued Date
2024-06-14
Resource Type
eISSN
15376591
Scopus ID
2-s2.0-85196228429
Pubmed ID
38180851
Journal Title
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume
78
Issue
6
Start Page
1617
End Page
1628
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Vol.78 No.6 (2024) , 1617-1628
Suggested Citation
Hoffman R.M., Brummel S., Ziemba L., Chinula L., McCarthy K., Fairlie L., Jean-Philippe P., Chakhtoura N., Johnston B., Krotje C., Nematadzira T.G., Nakayiwa F., Ndyanabangi V., Hanley S., Theron G., Violari A., João E., Correa M.D., Hofer C.B., Navanukroh O., Aurpibul L., Nevrekar N., Zash R., Shapiro R., Stringer J.S.A., Currier J.S., Sax P., Lockman S. Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate-Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Vol.78 No.6 (2024) , 1617-1628. 1628. doi:10.1093/cid/ciae001 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98987
Title
Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate-Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum
Author(s)
Hoffman R.M.
Brummel S.
Ziemba L.
Chinula L.
McCarthy K.
Fairlie L.
Jean-Philippe P.
Chakhtoura N.
Johnston B.
Krotje C.
Nematadzira T.G.
Nakayiwa F.
Ndyanabangi V.
Hanley S.
Theron G.
Violari A.
João E.
Correa M.D.
Hofer C.B.
Navanukroh O.
Aurpibul L.
Nevrekar N.
Zash R.
Shapiro R.
Stringer J.S.A.
Currier J.S.
Sax P.
Lockman S.
Brummel S.
Ziemba L.
Chinula L.
McCarthy K.
Fairlie L.
Jean-Philippe P.
Chakhtoura N.
Johnston B.
Krotje C.
Nematadzira T.G.
Nakayiwa F.
Ndyanabangi V.
Hanley S.
Theron G.
Violari A.
João E.
Correa M.D.
Hofer C.B.
Navanukroh O.
Aurpibul L.
Nevrekar N.
Zash R.
Shapiro R.
Stringer J.S.A.
Currier J.S.
Sax P.
Lockman S.
Author's Affiliation
Siriraj Hospital
FHI 360
Frontier Science & Technology Research Foundation, Inc.
University of the Witwatersrand Faculty of Health Sciences
UNC Project-Malawi
University of Zimbabwe
Harvard T.H. Chan School of Public Health
Universidade Federal de Minas Gerais
Beth Israel Deaconess Medical Center
UNC School of Medicine
National Institute of Child Health and Human Development (NICHD)
Brigham and Women's Hospital
University of the Witwatersrand, Johannesburg
University of KwaZulu-Natal
National Institutes of Health (NIH)
Johns Hopkins University
David Geffen School of Medicine at UCLA
Stellenbosch University
Chiang Mai University
Universidade Federal do Rio de Janeiro
Hospital Federal dos Servidores do Estado
Baylor College of Medicine Children's Foundation
MU-JHU Care Limited
FHI 360
Frontier Science & Technology Research Foundation, Inc.
University of the Witwatersrand Faculty of Health Sciences
UNC Project-Malawi
University of Zimbabwe
Harvard T.H. Chan School of Public Health
Universidade Federal de Minas Gerais
Beth Israel Deaconess Medical Center
UNC School of Medicine
National Institute of Child Health and Human Development (NICHD)
Brigham and Women's Hospital
University of the Witwatersrand, Johannesburg
University of KwaZulu-Natal
National Institutes of Health (NIH)
Johns Hopkins University
David Geffen School of Medicine at UCLA
Stellenbosch University
Chiang Mai University
Universidade Federal do Rio de Janeiro
Hospital Federal dos Servidores do Estado
Baylor College of Medicine Children's Foundation
MU-JHU Care Limited
Corresponding Author(s)
Other Contributor(s)
Abstract
BACKGROUND: We evaluated associations between antepartum weight change and adverse pregnancy outcomes and between antiretroviral therapy (ART) regimens and week 50 postpartum body mass index in IMPAACT 2010. METHODS: Women with human immunodeficiency virus (HIV)-1 in 9 countries were randomized 1:1:1 at 14-28 weeks' gestational age (GA) to start dolutegravir (DTG) + emtricitabine (FTC)/tenofovir alafenamide fumarate (TAF) versus DTG + FTC/tenofovir disoproxil fumarate (TDF) versus efavirenz (EFV)/FTC/TDF. Insufficient antepartum weight gain was defined using Institute of Medicine guidelines. Cox-proportional hazards regression models were used to evaluate the association between antepartum weight change and adverse pregnancy outcomes: stillbirth (≥20 weeks' GA), preterm delivery (<37 weeks' GA), small size for GA (<10th percentile), and a composite of these endpoints. RESULTS: A total of 643 participants were randomized: 217 to the DTG + FTC/TAF, 215 to the DTG + FTC/TDF, and 211 to the EFV/FTC/TDF arm. Baseline medians were as follows: GA, 21.9 weeks; HIV RNA, 903 copies/mL; and CD4 cell count, 466/μL. Insufficient weight gain was least frequent with DTG + FTC/TAF (15.0%) versus DTG + FTC/TDF (23.6%) and EFV/FTC/TDF (30.4%). Women in the DTG + FTC/TAF arm had the lowest rate of composite adverse pregnancy outcome. Low antepartum weight gain was associated with higher hazard of composite adverse pregnancy outcome (hazard ratio, 1.44 [95% confidence interval, 1.04-2.00]) and small size for GA (1.48 [.99-2.22]). More women in the DTG + FTC/TAF arm had a body mass index ≥25 (calculated as weight in kilograms divided by height in meters squared) at 50 weeks postpartum (54.7%) versus the DTG + FTC/TDF (45.2%) and EFV/FTC/TDF (34.2%) arms. CONCLUSIONS: Antepartum weight gain on DTG regimens was protective against adverse pregnancy outcomes typically associated with insufficient weight gain, supportive of guidelines recommending DTG-based ART for women starting ART during pregnancy. Interventions to mitigate postpartum weight gain are needed.