Antiretroviral therapy (ART) is a cornerstone in preventing mother-to-child transmission of HIV and maintaining maternal health during pregnancy. However, recent research from the Toronto General Hospital Research Institute (TGHRI) raises concerns about potential long-term effects of ART on fetal brain development and cognitive function.
Dr. Lena Serghides, Senior Scientist at TGHRI, acknowledges the crucial role of ART in reducing HIV transmission to newborns, thereby increasing the number of HIV-exposed but uninfected children. Despite these benefits, concerns persist regarding developmental risks associated with perinatal exposure to ART, particularly the inclusion of protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs).
Studies conducted at Dr. Serghides’ lab suggest that protease inhibitor-based ART regimens may impact early developmental milestones and contribute to cognitive and behavioral delays in experimental models. Specifically, exposure to ritonavir and atazanavir combinations, along with NRTIs, has shown associations with alterations in brain structure, gene expression in critical areas like the hippocampus, and deficits in memory and social behaviors.
“While the exact mechanisms behind these outcomes require further investigation, our findings underscore the importance of selecting ART regimens cautiously during pregnancy,” explains Dr. Shreya Dhume, a postdoctoral researcher in Dr. Serghides’ team.
The research highlights variability in outcomes depending on specific drug combinations, emphasizing the need for tailored approaches to minimize potential risks while maximizing maternal and child health outcomes. Dr. Kayode Balogun, formerly with TGHRI, notes distinct effects on brain volume and behavioral patterns observed with different ART regimens.
Moving forward, Dr. Serghides and her team aim to refine ART protocols to optimize maternal care without compromising fetal development. Their research aims to inform clinical decisions and improve understanding of how specific ART medications affect neurodevelopmental outcomes in children exposed during pregnancy.
“We are committed to identifying the safest ART options to support maternal health and promote optimal cognitive and behavioral development in HIV-exposed infants,” concludes Dr. Dhume, underscoring the ongoing efforts to mitigate risks associated with ART while enhancing its protective benefits for mothers and their children.
This ongoing research underscores the imperative for continued investigation into the long-term effects of ART exposure during pregnancy, aiming to refine treatment strategies and ensure comprehensive care for pregnant women living with HIV.
