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HIV/AIDS

Adverse Effects of Tenofovir Use in HIV-Infected Pregnant Women and their Infants

Staff Physician, St. Louis Veterans Affairs Medical Center; Instructor, Department of Medicine, School of Medicine, Washington University, St. Louis, MO

Nur F Onen, MD MRCP

Infectious Diseases Fellow, Department of Medicine, School of Medicine, Washington University

Ericka Hayes, MD

Instructor, Department of Pediatrics, School of Medicine, Washington University

Kristin Mondy, MD

Assistant Professor of Medicine, Department of Medicine, School of Medicine, Washington University

E Turner Overton, MD

Assistant Professor of Medicine, Department of Medicine, School of Medicine, Washington University

Reprints: Dr. Nurutdinova, St. Louis VA Medical Center, 915 North Grand Blvd., St. Louis, MO 63106, fax 314/289-7007, dnurutdi{at}im.wustl.edu

BACKGROUND: Data regarding use of tenofovir disoproxil fumarate in HIV-infected pregnant women are limited.

OBJECTIVE: To identify adverse effects of tenofovir use during pregnancy in HIV-infected women and their infants.

METHODS: In a retrospective case series, the charts of 127 pregnant HIV-infected women who received highly active antiretroviral therapy (HAART) between 2001 and 2005 were reviewed. Those who received tenofovir during pregnancy were selected for this study. Each woman's chart was reviewed for clinical data and adverse events during the pregnancy; each infant's chart was reviewed for growth parameters from birth to 12 months.

RESULTS: Fifteen HIV-infected women with limited treatment options were prescribed HAART containing tenofovir during 16 pregnancies. In utero tenofovir exposure was a median of 127 days (range 6–259). Tenofovir was well tolerated by all women throughout pregnancy. There were 15 successful deliveries occurring at a median (range) of 36 weeks (30–40), with a median birth weight of 3255 g (1135–3610). Complications, including 1 spontaneous abortion, occurred in 9 pregnancies and were not attributed to tenofovir. Eleven (73%) women had abnormal laboratory results, including 6 who experienced grade 1 hemoglobin abnormalities; 4 of these women had preexisting anemia. Calculated glomerular filtration rate (calculated by Modification of Diet in Renal Disease equation) remained above 90 mL/min/1.73 m² in all women, except one who had a transient decline. Fourteen infants demonstrated normal growth and development for weight and height at birth, as well as during the 12-month follow-up period; no congenital malformations were documented. Mother-to-child transmission of HIV was not observed in this cohort.

CONCLUSIONS: Tenofovir was found to be a well-tolerated component of HAART in this small cohort. Longer-term assessment of tenofovir effects on childhood growth and larger prospective studies of tenofovir use in pregnant women are warranted.

Key Words: HIV, pregnancy, tenofovir

Published Online, October 28, 2008. www.theannals.com, DOI 10.1345/aph.1L083