Treatment for Two

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Study finds HIV drugs alter levels of a hormone that is critical to a healthy pregnancy.
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Newborn children of HIV-1–infected mothers may be exposed to antiretroviral drugs in the womb or during breast feeding.

A healthy pregnant woman translates to a healthy baby. It’s the reason why many women go to great lengths to improve their health once they become pregnant. But as TGHRI Scientist Dr. Lena Serghides has discovered in two recent studies, women who are infected with the human immunodeficiency virus (HIV) face greater challenges when trying to ensure their baby’s health.

HIV-positive pregnant women are advised to take a drug regimen—commonly referred to as combination antiretroviral therapy (cART)—to prevent mother-to-child transmission of the virus. Unfortunately, these antiretroviral regimens are often associated with a number of adverse birth outcomes, including preterm delivery and low birth weight.

To examine the effects of these treatments, Dr. Serghides and her team measured the levels of several different hormones in pregnant women, before and after they were randomly assigned to take two different cART regimens.

The team found that levels of the hormone, estradiol, were decreased with one type of cART regimen and increased with the other. These changes were linked to significantly lower birth weight, suggesting that hormonal changes may contribute to the cART-associated fetal growth restriction.

“The cART regimens that were used both prevent the virus from replicating, but target the virus through different mechanisms,” says Dr. Serghides. “The results of our study underscore the need for more research on the long-term effects of these regimens as they may affect fetal development by differentially altering hormone levels.”

This work was supported by the Canadian Institutes of Health Research, the Ontario HIV Treatment Network G655, the Canadian Foundation for AIDS Research, the Global Alliance to Prevent Prematurity and Stillbirth and Grand Challenges in Global Health: Preventing Preterm Birth Initiative. KC Kain holds a Tier 1 Canada Research Chair in Molecular Parasitology.

McDonald CR, Conroy AL, Gamble JL, Papp E, Hawkes M, Olwoch P, Natureeba P, Kamya M, Silverman M, Cohan D, Koss CA, Dorsey G, Kain KC, Serghides L. Estradiol levels are altered in human immunodeficiency virus-infected pregnant women randomized to efavirenz-versus lopinavir/ritonavir-based antiretroviral therapy. Clin Infect Dis. 2017 Nov 10. doi: 10.1093/cid/cix772.

Balogun KA, Lenis MG, Papp E, Loutfy M, Yudin MH, MacGillivray J, Walmsley SL, Silverman M, L. Serghides. Elevated levels of estradiol in HIV-positive pregnant women on protease inhibitor-based regimens. Clin Infect Dis. 2017 Aug 24. doi: 10.1093/cid/cix761.