HIV medication during pregnancy
In 2018, there was concern that the widely used HIV medication dolutegravir (Tivicay, also included in Triumeq, Dovato and Juluca) might be linked to a higher rate of birth defects. The data came from a cohort of pregnant women and their babies in Botswana. It led to a temporary slowdown in the worldwide rollout of dolutegravir, which is generally considered to be one of the safest and most effective HIV medications available.
Further data, both from Botswana and other countries, led to the initial warning about dolutegravir to be revised. When information from a larger number of pregnancies was included, there was no longer a significantly higher number of neural tube defects – such as spina bifida – in babies whose mothers had taken dolutegravir during pregnancy. It’s possible that the initial result was due to chance, as can sometimes happen with statistics, especially when smaller numbers of people are included in studies.
Experts also raised concerns that the initial data came from Botswana, a country where folic acid (vitamin B9) is not widely used during pregnancy. Folic acid protects against neural tube defects, which is the reason pregnant women in many countries are advised to take a folic acid supplement. Food manufacturers may also be obliged to fortify flour, cereals, and other foods with folic acid.
A very large new study from the US should reassure anyone who is taking dolutegravir during pregnancy. The researchers from the Centers for Disease Control and Prevention (CDC) looked at over 18 million pregnancies between 2008 and 2020, including over 64,000 pregnant people living with HIV. There were just over 1500 pregnancies in which dolutegravir was taken from before conception to at least the end of the first trimester (12 weeks of pregnancy). This is the most critical period for the developing foetus.
Only one baby exposed to dolutegravir had a neural tube defect, which was in line with the number of cases that might be expected in the general population. There was no increase in the rates of neural tube defects when comparing:
- babies exposed to dolutegravir with babies of HIV-negative mothers
- babies exposed to dolutegravir with babies exposed to other HIV medications
- babies exposed to HIV medication with babies of HIV-negative mothers.
The British HIV Association (BHIVA) has specific advice on folic acid for people taking dolutegravir. If you are trying to become pregnant or are in the first trimester (12 weeks) of pregnancy, you are recommended to take a higher dose of folic acid (5mg once a day).
Do I have to tell anyone that I have HIV?
Telling people that you are living with HIV can be a difficult decision to make. Stigma surrounding HIV means that people may be quick to make judgements about you or your behaviour. However, sharing your status may also unburden you and provide important forms of support that you may need.
Our updated page outlines some general considerations regarding sharing your status or deciding to keep it private.
Mental health
Research from south London shows the overlap between HIV and mental health challenges. Whereas several previous studies have looked at people attending HIV services and have shown higher rates of mental health issues than among other people, the new study looked at the problem from the other way round. The researchers looked at people attending mental health services to see how many also had HIV.
They found that 2.5% of people using mental health services in south London had been diagnosed with HIV. This compares to an HIV rate of 1% in the general population in the local area.
The most frequent mental health diagnoses among those who also had HIV were substance disorders (problems with alcohol or drugs), mood disorders (such as depression and bipolar disorder), and neurotic or stress-related disorders (such an anxiety or post-traumatic stress disorder).
The researchers say the links between HIV and mental health are complex. The higher rate they found may be because people with mental health needs have a higher risk of acquiring HIV, or that people with HIV have an increased risk of developing mental ill health. For example, this could be due to the challenges of dealing with a stigmatised illness. Both HIV and mental health problems are also linked to social factors and inequalities.
But they say their study highlights the need for a closer integration of HIV and mental health services. HIV services should be paying attention to mental health, and mental health services should be making sure that their patients’ HIV needs are being addressed.
aidsmapLIVE
Last week, we held an aidsmapLIVE broadcast on HIV and maximising your health. NAM aidsmap's Susan Cole was joined by guests: Dr Tristan Barber, Consultant Physician in HIV Medicine at the Royal Free Hospital; Leasuwanna Griffith, nursing associate and HIV activist; Jack Summerside, Head of Health and Wellbeing at Positive East; Angelina Namiba, co-director of the 4M Network of Mentor Mothers; and Michelle Bockor, Youth Programme Coordinator at Positively UK.
Fatty liver disease
Fatty liver disease occurs when triglycerides (fats in your blood) and other fats build up in the liver. This can cause inflammation and interfere with normal liver function. Fatty liver disease is becoming more common as the number of people who are overweight rises.
The more overweight you are – especially if you have excess fat around your waistline – the greater your risk of having fatty liver disease. Research also shows that people with HIV are more likely to develop fatty liver disease than HIV-negative people.
A new study shows that people with HIV who have fatty liver disease have a higher risk of serious cardiovascular outcomes including heart attack, heart failure and stroke. These raised risks are seen in HIV-negative people who have fatty liver disease, but they haven’t been shown in a large study of people with HIV before. The US study included over 370,000 people with HIV, including almost 5000 who had fatty liver disease.
Fatty liver disease may be detected through liver function tests that are routinely done at your HIV clinic. There aren’t yet any approved treatments for the condition, although some are being researched. The condition is managed through eating a healthy diet, being more physically active and (if needed) losing weight.
Harm reduction
Harm reduction aims to reduce the negative impacts of drug use on the health of people who use drugs. It helps prevent overdoses and reduce the transmission of HIV, hepatitis B and hepatitis C.
Read about different harm reduction methods – including needle and syringe exchanges, opioid agonist treatment and drug-checking services – in our new page.
Editors' picks from other sources
European Commission authorises ViiV Healthcare’s Apretude (cabotegravir long-acting and tablets) for HIV prevention | ViiV Healthcare
Cabotegravir is indicated in combination with safer sex practices for pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in high-risk adults and adolescents (at least 12 years of age), weighing at least 35 kg.
Antiretroviral dose adjustment is rarely needed for obese people with HIV, modelling study suggests | TheBodyPro
Except for a few specific situations, antiretroviral drug doses do not need to be adjusted for people who are obese, even though drug exposure and trough concentrations are generally lower in those who are obese compared to non-obese people living with HIV, reports a modelling study in Switzerland.
For ‘silver tsunami’ with HIV, new hope for healthy ageing | The New York Times
The medical research community, which some three decades ago developed lifesaving drugs to keep the virus at bay, is now hunting for new ways to keep people with HIV healthier in their later years. “I have been unbelievably impressed at how care for the older HIV population has really exploded,” said Dr Nathan Goldstein, who heads one such clinic at Mount Sinai in New York City.