How safe is HIV treatment in pregnancy?

One concern many women living with HIV have is about whether taking antiretroviral medications during pregnancy poses any risk to their unborn child. The treatment protects the foetus from HIV, but could it have any side-effects?

Some people have asked in particular whether the medications might have an impact on the infant’s brain, or on his or her cognitive abilities later in life.

A unique study from Malawi and Uganda provides some reassuring answers. The researchers had data on 861 infants. All children were HIV negative, but some were born to mothers living with HIV and some were born to HIV-negative women.

The children born to mothers living with HIV had all been exposed to antiretroviral medications while in the womb. Some infants had also taken an anti-HIV drug for the first few weeks after birth and been exposed to the medications through breast milk.

All children took a series of tests of memory, language, hand/eye co-ordination, problem solving and so on, once a year, up to five years of age.

The results were the same in the children who had been exposed to HIV and anti-HIV drugs, and in the children who had not.

The study shows we can be confident that antiretrovirals are good for the mother’s health, prevent HIV transmission to the infant, and cause no harm to the infant in the medium term.

For more information, read NAM's factsheet 'HIV and having a baby'.

Hair loss as a side-effect

Doctors in Detroit have reported that six black women taking the relatively new anti-HIV drug tenofovir alafenamide (TAF) suffered hair loss. This hasn’t been previously reported as a side-effect of the medication.

Many HIV drug combinations contain either tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF). They are both nucleoside transcriptase inhibitors: TDF has been available for almost 20 years, with the newer formulation TAF becoming available in the last few years.

TAF is included in the tablets Descovy, Odefsey, Genvoya, Symtuza and Biktarvy.

The six women were aged between 40 and 61 years. All had been taking a TDF-containing combination and switched to the newer tenofovir formula. Four of the six women noticed a loss of hair on their head within four months of switching, while this appeared a few months later for the other two.

In an attempt to reverse the hair loss, five of the women changed medications again. The hair started to grow back within a few months. This led their doctors to conclude that TAF was the culprit and they were able to rule out other causes.

Hair loss wasn’t reported as a side-effect of the drug in the clinical trials that examined its safety and efficacy. However, clinical trials typically recruit far more men than women, and far more white than black people. As a result, issues that are unique to sub-groups might not be noticed in the trials. This shows the importance of clinical trials recruiting a more diverse mix of participants.

For more information on tenofovir, read NAM's factsheet.

Drug-drug interactions

Drug-drug interactions are common in people over the age of 65 living with HIV, according to a French study. As many as 17% of ageing individuals had an identified drug-drug interaction. Interactions were especially common in people taking antiretroviral drugs ‘boosted’ with ritonavir or cobicistat.

A drug-drug interaction (DDI) is the impact of a drug A on a drug B that can lead to increases in concentrations of drug B – and in risks of side-effects. Conversely, it could lead to decreases in those concentrations and risks of lesser efficacy. Some drug interactions can therefore lead to severe health issues that require medical attention.

For more information, read NAM's factsheet 'Multiple medications and drug interactions.'