Effect of tenofovir alafenamide in combination with and without integrase inhibitors on weight gain, diabetes, and hypertensive disorders of pregnancy.

Objectives: We sought to determine if tenofovir alafenamide (TAF) was associated with excessive weight gain, diabetes (DM), and hypertensive disorders of pregnancy (HDP) in persons with HIV.

Study Design: This is a retrospective cohort study of pregnant persons with HIV prescribed antiretroviral therapy (ART) during the period of 01/01/2009 to 12/31/2020.

Main Outcomes Measures: χ2 tests were used to compare the proportion of persons with excessive weight gain, DM, and HDP according to ART regimens. Excess total gestational weight gain was calculated using BMI and Institute of Medicine recommendations for weight gain in pregnancy. HDP included gestational hypertension and preeclampsia. Logistic regression models were used to determine predictors of excessive weight gain, DM, and HDP.

Results: We identified 189 pregnant persons prescribed ART with (30) and without TAF (159). The percentage of persons with excessive gestational weight gain was not significantly different in persons prescribed TAF (32 %) and other ART (17 %), p = 0.2. Persons prescribed TAF were more likely to have HDP (30 %) compared to other ART (9 %), p = 0.001. In the adjusted analysis, DM [aOR 6.2 (95 % CI 1.2-32.7)] and TAF exposure [aOR 3.2 (95 % CI 1.0-8.9)] were significantly associated with HDP.

Conclusion: Despite similar gestational weight gain, persons with HIV prescribed TAF were more likely to have HDP. Further understanding of the metabolic and cardiovascular impact of ART recommended for use during pregnancy is needed.