Influence of maternal use of tenofovir disoproxil fumarate or zidovudine in Vietnamese pregnant women with HIV on infant growth, renal function, and bone health

• Published in: PloS one Vol. 16; no. 4; p. e0250828
• Main Authors: Kinai, Ei, Nguyen, Hoai Dung Thi, Do, Ha Quan, Matsumoto, Shoko, Nagai, Moeko, Tanuma, Junko, Nguyen, Kinh Van, Pham, Thach Ngoc, Oka, Shinichi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.04.2021; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Diseases; Drug therapy; Growth disorders; Health aspects; HIV patients; Infants (Newborn); Kidney diseases; Medicine and Health Sciences; Patient outcomes; People and Places; Physical Sciences; Pregnant women; Prenatal drug exposure; Risk factors; Tenofovir; Zidovudine; Vietnam
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250828

Tenofovir disoproxil fumarate (TDF) is still widely prescribed for human immunodeficiency virus (HIV)-infected pregnant women, despite its renal and bone toxicity. Although TDF-exposed infants often show transient growth impairment, it is not clear whether maternal TDF causes infantile rickets via maternal/fetal renal dysfunction in Asian populations. This prospective observational study was conducted in Vietnam and involved pregnant HIV-infected women treated with TDF-based regimen (TDF group) or zidovudine-based regimen (AZT-group). At birth, 3, 12, and 18 months of age, and included body length, weight, head circumference, serum alkaline phosphatase (ALP), creatinine, calcium, phosphorus, urine-β2-microglobulin (U-BMG), percentage of tubular reabsorption of phosphate (%TRP), and radiographic wrist score for rickets. Age-adjusted multivariate linear regression analysis evaluated the association of TDF/AZT use during pregnancy with fetal renal function and bone health. The study included 63 mother-infant pairs (TDF group = 53, AZT group = 10). In the mothers, detectable U-BMG (>252 μg/L) was observed more frequently in the TDF- than AZT group (89 vs 50%, p<0.001), but other renal/bone parameters were similar. In infants, maternal TDF use was not associated with growth impairment, renal dysfunction, or abnormal bone findings, but with a slightly higher ALP levels (p = 0.019). However, shorter length was associated with maternal AZT (p = 0.021), and worse radiographic scores were associated with LPV/r (p = 0.024). In Vietnamese population, TDF usage during pregnancy was not associated with infant transient rickets, growth impairment, or renal dysfunction, despite mild maternal tubular impairment. Maternal AZT and LPV/r influenced infant growth and bone health, though further studies are needed to confirm this finding.