Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate–Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum
Creators: name: Clark, Rich
name: Kiattivej, Sopida
name: Sitiritkawin, Lukkana
name: Mid, Dip Nus
name: McCarthy, Katie
name: Chakhtoura, Nahida
name: Vhembo, Tichaona
name: Maraqa, Nizar
name: Rolla, Valeria Cavalcanti
name: Drada, Adriana
name: Fairlie, Lee
name: Rossouw, Magdel
name: Hofer, Cristina Barroso
name: Nunn, Andrew J
name: Sidi, Leon Claude
name: Pilotto, Jose Henrique
name: Pestanha, Lorena Macedo
name: Kabugo, Enid
name: Epi, Hons Clin
name: Hons, Bpharm
name: Coletti, Anne
name: Oliveira, Ricardo Hugo
name: Murtaugh, William
name: Alvarez, Grace A
name: Rungmaitree, Supattra
name: Rossouw, Lindie
name: Theron, Gerhard
name: Klingman, Karin
name: Stranix-Chibanda, Lynda
name: de Abreu, Thalita Fernandes
name: Patras, Emmanuel
name: Nagaddya, Beatrice
name: Mhembere, Tsungai
name: Violari, Avy
name: Gazu, Rosemary
name: Knowles, Kevin
name: Mave, Vidya
name: Jaliaah, Nagawa
name: Werarak, Peerawong
name: Whalen, Frances
name: Ashaba, Justus
name: Shabbir, Adnan
name: Nachman, Sharon
name: Blanchette, Cheryl
name: Cressey, Tim R
name: Naik, Shilpa
name: de Jager, Jeanne
name: Pinto, Jorge
name: McIntyre, James
name: Govender, Vani
name: Budu, Marian E
name: Nyati, Mandisa
name: Tamirepi, Kevin
name: Mwinga, Alwyn
name: Fernandes, Luis Eduardo Barros Costa
name: Mutambanengwe, Mercy
name: Shapiro, Roger
name: Volberding, Paul A
name: Matubu, Taguma Allen
name: Krotje, Chelsea
name: Soma-Kasiram, Hamisha
name: Joffe, Steven
name: Saloojee, Haroon
name: Patel, Faeezah
name: Moreira, Luiz Felipe
name: Cheng, Yao
name: Seme, Boitshepo J
name: Lockman, Shahin
name: Tsiatis, Anastasios A
name: Chidemo, Tinashe
name: Aurpibul, Linda
name: Gomes, Ivete Martins
name: Mirochnick, Mark
name: Maonera, Suzen
name: Chinula, Lameck
name: Rathore, Mobeen
name: Sekabira, Rogers
name: Murtaugh, William
name: Mathiba, Sisinyana Ruth
name: Kinikar, Aarti
name: Cassim, Haseena
name: Pinilla, Mauricio
name: Hoffman, Risa M
name: Desmondarm, Alicia Catherine
name: Nursing, Dip
name: Brummel, Sean
name: Moyo, Sikhulile
name: Mofenson, Lynne
name: Tongprasert, Fuanglada
name: Sukrakanchana, Pra-ornsuda
name: Zash, Rebecca
name: Raesi, Dip Nursingo S
name: Ziemba, Lauren
name: Ferreira, Flãvia
name: Currier, Judith S
name: Wabwire, Deo
name: Tirelo, Lesedi
name: Maturure, Sukunena
name: Ray, Stuart Campbell
name: Masheto, Gaerolwe
name: McCallister, Scott
name: Sax, Paul
name: van Wyk, Jean
name: Nursing, Dip
name: Fuller, Trevon
name: Ramogodiri, Moakanyi
name: Scott, Gwendolyn B
name: Correa, Mario Dias
name: Robertson, Kevin
name: Mandima, Patricia Fadzayi
name: Frenkel, Lisa
name: MahmoudiN, Saniyyah
name: Molepolole, Gaborone
name: Amico, K Rivet
name: Piper, N C Jeanna
name: Cruz, Maria Leticia Santos
name: Murray, Barbara E
name: Holmes, Lewis Ball
name: Hill, Catherine
name: Kimmelman, Jonathan
name: Momper, Jeremiah
name: Horne, Elizea
name: Fairlie, Lee
name: Khamrong, Chintana
name: Jean-Philippe, Patrick
name: Ponatshego, Ponego L
name: Modise, Georginah O
name: Purdue, Lynette
name: Stringer, Jeffrey S A
name: Glidden, David
name: Chalermchockcharoenkit, Amphan
name: Achalapong, Jullapong
name: Robb, Merlin L
name: Knowles, Kevin
name: van Wyck, Jean
name: Whalen, Frances
name: Fox, Andi
name: Romeiro, Juliana
name: Mitchell, Charles D
name: Nevrekar, Neetal
name: Best, Brookie
name: Ndyanabangi, Victoria
name: Rooney, Jim
name: Robb, Merlin L
name: Navanukroh, Oranich
name: Harrington, David P
name: Johnston, Ben
name: Hanley, Sherika
name: Saloojee, Haroon
name: Maena, Joel
name: Thamkhantho, Manopchai
name: Nematadzira, Teacler G
name: Chanaiwa, Vongai
name: Nursing, Dip
name: McCallister, Scott
name: Bhattacharya, Debika
name: João, Esau
name: Meintjes, Graeme A
name: Nakayiwa, Frances
Publisher: name: Oxford University Press (OUP)
Year: 2024

description: 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.