Are Babies Exposed to HIV in Utero at Risk for Obesity in Adolescence?

The advent of antiretroviral therapy (ART) to treat HIV has been life-changing for those infected with the virus. One group for which it has made a particular impact is pregnant women, who previously were at great risk of passing HIV to their babies. When properly treated with ART, the risk of HIV transmission from mother to offspring in utero or during delivery drops to less than 1%. Investigators have found, however, that there still may be negative effects on children born to mothers with HIV who take ART, even if they don’t develop HIV themselves.

The investigators, based at Massachusetts General Hospital in Boston, conducted a study of 50 people between the ages of 13 and 28 who had been exposed to HIV in utero, almost all of whom had mothers who received ART while pregnant. A control group of 141 age-matched subjects whose mothers did not have HIV while pregnant was added. The control group also was matched to the HIV-exposed group by gender, race, ethnicity, and zip code. Although one-quarter of the control-group subjects were obese as measured by body mass index (BMI), 42% of the subjects whose mothers took ART during pregnancy were found to be obese. In addition, 24% of the control group had reactive airway disease, which mimics asthma, while 40% of the subjects whose mothers had HIV during pregnancy had the condition. The results were presented at the annual meeting of the Endocrine Society in March.

The investigators found that the greater CD4 level during pregnancy, the greater the body mass index of her child in adolescence. “We find an inverse relationship between maternal prenatal CD4 count and...adolescent BMI,” Lindsay Fourman, MD, an instructor at Massachusetts General Hospital and lead author of the study, told Contagion®. “From this, we hypothesize that maternal immune dysregulation during pregnancy may be an important driver of obesity among [these] adolescents.”

Lindsay Fourman, MD

The investigators are not sure how much of the problem is due to the infection or to its antidote, although they’re leaning toward putting the blame on HIV itself. “We cannot entirely parse out whether our findings were due to HIV exposure versus ART exposure since almost all (93%) of our HIV+ mothers received antiretroviral therapy,” said Fourman. “However, there was no association between ART class and long-term outcomes, which argues against a relationship with ART.”

Because pregnant women with HIV are at such high risk of transmitting the infection to their babies if they don’t get treatment, ART remains the standard of care. Nevertheless, the investigators’ findings highlight that simply avoiding HIV transmission doesn’t mean these children are in the clear, health wise. “Our data suggest that children of mothers with HIV—even those without HIV infection—should be closely monitored over the life course for the potential development of metabolic disease,” Fourman said. She added that mothers should be encouraged to let their children know of their HIV status so that they can work with their doctors and take appropriate tests, if necessary, as they grow.

The investigators are hoping to identify specific steps that can be taken so that children of mothers with HIV are not at risk of obesity or reactive airway disorder; however, additional research is needed in order to get to that point. Currently, scientists are unsure of the exact mechanisms and processes by which metabolic dysfunction occurs in fetuses whose mothers take ART. “[T]he identification of preventative measures is an ultimate goal of our work,” Fourman said.