Raltegravir-based combined antiretroviral therapy and weight gain in HIV-positive pregnant women
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on November 23rd, 2022
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Reducing viral load is extremely essential for HIV-positive women who are pregnant; thus, raltegravir was recommended due to its low toxicity. Studies conducted on non-pregnant adults and adolescents had reported that the antiretroviral induce weight gain. For pregnant women, this can increase the risk of peripartum diabetes, peripartum hypertension, postpartum weight retention, etc. This can also affect the fetus by causing macrosomia, offspring obesity, which increase the likelihood of cesarean delivery. A recent study had reported on the risk of peripartum weight gain of HIV-positive pregnant women who are using raltegravir.
The phase 4 multinational clinical trial included 408 pregnant women with a gestational age between 20 and 36 weeks. These women are living with HIV, and either have never used antiretroviral or have only been using zidovudine for a maximum of 8 weeks. These women were randomly assigned to receive either the integrase inhibitor, raltegravir 400 mg twice a day, or efavirenz 600 mg once a day, a non-nucleotide reverse transcriptase inhibitor. The treatment was started within 7 days of enrollment in the study and continued until delivery. Comparison between the two treatment arms show that women who were receiving raltegravir gain weight at a faster rate (0.36 kg/week) than those who were receiving efavirenz (0.29 kg/week). This translates to a faster rate of increase in body mass index in the integrase inhibitor group. This higher rate of weight gain in this group can potentially be explained by the fact that previous studies have reported that the agent increases the rate of lipid accumulation by adipogenesis. The research group concluded that raltegravir is an effective antiretroviral treatment, but healthcare professionals should be aware of its effect on weight gain. Further studies with longer surveillance periods must be conducted to help us understand the long term effects of weight gain induced by raltegravir and other adverse pregnancy outcomes.
The phase 4 multinational clinical trial included 408 pregnant women with a gestational age between 20 and 36 weeks. These women are living with HIV, and either have never used antiretroviral or have only been using zidovudine for a maximum of 8 weeks. These women were randomly assigned to receive either the integrase inhibitor, raltegravir 400 mg twice a day, or efavirenz 600 mg once a day, a non-nucleotide reverse transcriptase inhibitor. The treatment was started within 7 days of enrollment in the study and continued until delivery. Comparison between the two treatment arms show that women who were receiving raltegravir gain weight at a faster rate (0.36 kg/week) than those who were receiving efavirenz (0.29 kg/week). This translates to a faster rate of increase in body mass index in the integrase inhibitor group. This higher rate of weight gain in this group can potentially be explained by the fact that previous studies have reported that the agent increases the rate of lipid accumulation by adipogenesis. The research group concluded that raltegravir is an effective antiretroviral treatment, but healthcare professionals should be aware of its effect on weight gain. Further studies with longer surveillance periods must be conducted to help us understand the long term effects of weight gain induced by raltegravir and other adverse pregnancy outcomes.