Protease Inhibitor–Based Antiretroviral Therapy and Fetal Growth Restriction

Mechanistic studies provide support that the association is mediated by low progesterone.

The success of antiretroviral (ARV) therapy for preventing maternal-to-child HIV transmission has been tempered by excess risk for preterm birth, especially among pregnant women who receive protease inhibitors (PIs). Various data have suggested that low progesterone may play a role. To further investigate this mechanism, investigators conducted a series of experiments in cell lines and mice and an observational study in 44 pregnant women with or without HIV infection.

When trophoblastic progesterone-producing cells were exposed to ARVs, protease inhibitors (except darunavir) but not nucleoside reverse transcriptase inhibitors (NRTIs) or non-NRTIs resulted in diminished progesterone release. Pregnant mice treated with PI-containing ARV combin…

Reviewing Author

Anna Wald, MD, MPH

Disclosures

Consultant/Advisory BoardAicuris; Bayer; GSK; Innovative Molecules; Merck; MAPP Biopharmaceutical (Safety Monitoring Committee)

RoyaltiesUpToDate

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; GSK; Moderna; Assembly Biomedical; Aicuris

Editorial BoardsSexually Transmitted Diseases; Sexually Transmitted Infections; Journal of Infectious Diseases

Leadership PositionsID Division Chiefs Community of Practice (At-Large Member)