The prevalence of neural tube defects, or NTDs, among children born to women with HIV was found to be the same as that among newborns from the general U.S. population, according findings published in MMWR.
Initially, the risk for NTDs was elevated among infants born to women who took dolutegravir for HIV infection during a study in Botswana. Later analysis showed that the risk was lower than originally thought, and as a result WHO strengthened its recommendation that the integrase inhibitor should be used as first-line treatment for all populations, including pregnant women. U.S. recommendations also state that the drug should be used during pregnancy. Results from the MMWR appear to support those recommendations.
However, researchers cautioned that ongoing study is needed.
“Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy,” Jennita Reefhuis, PhD, chief of the CDC’s National Center on Birth Defects and Developmental Disabilities’ Birth Defects Monitoring and Research Branch, and colleagues wrote.
For the report, Reefhuis and colleagues linked data from two CDC surveillance programs — one that records birth defects in the U.S. and another that monitors trends in HIV/AIDS. The analysis included 8,043,489 live births between 2013-2017.
Eight NTD cases among 11,425 live births to women with HIV were identified for a prevalence of seven NTD cases per 10,000 HIV-exposed live births. Similarly, NTD prevalence in the general population was found to be seven per 10,000 live births when the analysis was limited to U.S. jurisdictions with active surveillance systems, which have more complete data than do passive systems, which yielded a prevalence of 4.7 per 10,000.
“Data on pregnancy and ongoing antiretroviral medication use are not routinely collected by many HIV surveillance programs,” Reefhuis explained to Healio. “Identifying strategies to collect that information going forward would enable us to answer more specific questions about risks of birth defects and adverse pregnancy outcomes with the use of specific antiretroviral medications.”
Meanwhile, Reefhuis said the comparable rates of NTDs among HIV-exposed children and the general population should “offer reassurance” to pregnant women with HIV. – by Eamon Dreisbach
Disclosure: Reefhuis reports no relevant financial disclosures.