Eke Ahizechukwu C, Brummel Sean S, Aliyu Muktar H, Stranix-Chibanda Lynda, Eleje George U, Ezebialu Ifeanyichukwu U, Korutaro Violet, Wabwire Deo, Matubu Allen, Mbengeranwa Tapiwa, Chakhtoura Nahida, Chinula Lameck, McCarthy Katie, Knowles Kevin, Krotje Chelsea, Linton Macrae F, Dooley Kelly E, Sax Paul E, Brown Todd, Lockman Shahin
Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Clin Infect Dis. 2025 Mar 17;80(3):594-601. doi: 10.1093/cid/ciae441.
Tenofovir alafenamide (TAF)-based antiretroviral therapy (ART) regimens have been associated with adverse changes in lipid and glucose profiles compared with tenofovir disoproxil fumarate (TDF)-based ART, but data in pregnancy are limited. We evaluated metabolic markers in pregnant women with human immunodeficiency virus (HIV) after starting TAF- versus TDF-based ART.
We analyzed data within the IMPAACT 2010/VESTED trial, which demonstrated better pregnancy outcomes in pregnant women randomized to initiate TAF/Emtricitabine/Dolutegravir (TAF/FTC + DTG; n = 217) or TDF/FTC + DTG (n = 215). We measured non-fasting plasma concentrations of glucose, total-cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), lipoprotein (a), and triglycerides from samples collected 8 weeks after enrollment. We employed linear regression models to estimate by-arm mean differences.
In total, 219 participants enrolled in the DTG arms in Zimbabwe and Uganda: 109 in the TAF/FTC + DTG and 110 in the TDF/FTC + DTG arms. At study entry, mean gestational age was 22.6 weeks, median HIV-1 RNA was 711 copies/mL, and mean age was 25.8 years. By 8 weeks, mean total cholesterol was 12 mg/dL higher in women randomized to TAF/ FTC + DTG versus TDF/FTC + DTG (95% confidence interval [CI]: 3.8, 21.1). Pregnant women in the TAF/FTC + DTG arm had higher mean LDL-C (7.1 mg/dL, 95% CI: .2, 14.0), triglycerides (12.3 mg/dL, 95% CI: 1.8, 22.7), lipoprotein (a) (7.3 mg/dL, 95% CI: 1.1, 13.6), and lower mean HDL-C (2.8 mg/dL, 95% CI: .1, 5.6) compared to the TDF/FTC + DTG arm.
Pregnant women randomized to start TAF/FTC + DTG had higher lipids than those randomized to TDF/FTC + DTG within 8 weeks of ART initiation. However, lipid levels were within normal reference ranges.
与基于替诺福韦酯（TDF）的抗逆转录病毒疗法（ART）相比，基于替诺福韦艾拉酚胺（TAF）的ART方案与脂质和葡萄糖谱的不良变化有关，但孕期数据有限。我们评估了开始基于TAF与TDF的ART治疗后，感染人类免疫缺陷病毒（HIV）的孕妇的代谢指标。
我们分析了IMPAACT 2010/VESTED试验中的数据，该试验表明，随机开始使用TAF/恩曲他滨/多替拉韦（TAF/FTC + DTG；n = 217）或TDF/FTC + DTG（n = 215）的孕妇有更好的妊娠结局。我们测量了入组8周后采集的样本中非空腹血浆葡萄糖、总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、脂蛋白（a）和甘油三酯的浓度。我们采用线性回归模型来估计各组之间的平均差异。
在津巴布韦和乌干达，共有219名参与者进入了DTG组：109名在TAF/FTC + DTG组，110名在TDF/FTC + DTG组。在研究开始时，平均孕周为22.6周，HIV-1 RNA中位数为711拷贝/mL，平均年龄为25.8岁。到8周时，随机分配到TAF/FTC + DTG组的女性的平均总胆固醇比TDF/FTC + DTG组高12 mg/dL（95%置信区间[CI]：3.8，21.1）。与TDF/FTC + DTG组相比，TAF/FTC + DTG组的孕妇平均LDL-C更高（7.1 mg/dL，95% CI：0.2，14.0）、甘油三酯更高（12.3 mg/dL，95% CI：1.8，22.7）、脂蛋白（a）更高（7.3 mg/dL，95% CI：1.1，13.6），而平均HDL-C更低（2.8 mg/dL，95% CI：0.1，5.6）。
随机开始使用TAF/FTC + DTG的孕妇在开始ART治疗8周内的血脂水平高于随机使用TDF/FTC + DTG的孕妇。然而，血脂水平在正常参考范围内。
