Maternal Use of Integrase Strand Transfer Inhibitors During Pregnancy and Infant Neurodevelopment.

Area of Science:

• Perinatal HIV research
• Infant neurodevelopmental outcomes
• Antiretroviral therapy (ART) safety

Background:

• Current guidelines recommend integrase strand transfer inhibitors (INSTIs) for perinatal HIV treatment.
• Limited data exist on the safety of INSTIs concerning infant neurodevelopment.

Purpose of the Study:

• To compare neurodevelopmental outcomes in infants exposed in utero to INSTI-based ART regimens versus PI-based or NNRTI-based regimens.
• To assess the impact of ART timing on neurodevelopmental outcomes.

Main Methods:

• Prospective cohort study in 22 US academic centers (2012-2023).
• Included 1006 HIV-exposed, uninfected infants assessed at 1 year using Bayley Scales of Infant and Toddler Development (Bayley-III).
• Compared cognitive, language, and motor domain scores, adjusting for confounders and stratifying by ART initiation timing.

Main Results:

• No significant neurodevelopmental differences were found between infants exposed to INSTI-based and PI-based ART regimens.
• INSTI-exposed infants showed slightly lower mean scores in cognitive, language, and motor domains compared to NNRTI-exposed infants.
• These differences were more pronounced when maternal ART initiation occurred after conception.

Conclusions:

• Infant neurodevelopmental outcomes were comparable between INSTI-based and PI-based ART regimens.
• While INSTI-exposed infants had slightly lower scores than NNRTI-exposed infants, cognitive scores remained near population norms.
• Findings support the continued use of INSTIs in first-line ART for pregnant women with HIV.