Lower Insulin Sensitivity in Newborns with in Utero HIV and Antiretroviral Exposure Who Are Uninfected in Botswana

Jennifer Jao, Shan Sun, Lauren B. Bonner, Justine Legbedze, Keolebogile N. Mmasa, Joseph Makhema, Mompati Mmalane, Samuel Kgole, Gosego Masasa, Sikhulile Moyo, Mariana Gerschenson, Terence Mohammed, Elaine J. Abrams, Irwin J. Kurland, Mitchell E. Geffner, Kathleen M. Powis

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background. Few data exist on early-life metabolic perturbations in newborns with perinatal HIV and antiretroviral (ARV) exposure but uninfected (HEU) compared to those perinatally HIV unexposed and uninfected (HUU). Methods. We enrolled pregnant persons with HIV (PWH) receiving tenofovir (TDF)/emtricitabine or lamivudine (XTC) plus dolutegravir (DTG) or efavirenz (EFV), and pregnant individuals without HIV, as well as their liveborn infants. Newborns were randomized to receive either zidovudine (AZT) or nevirapine (NVP) postnatal prophylaxis. Preprandial homeostasis model assessment for insulin resistance (HOMA-IR) was assessed at birth and 1 month. Linear mixed models were fit to assess the association between in utero HIV/ARV exposure and average HOMA-IR from birth to 1 month, adjusting for confounders. Results. Of 450 newborns, 306 were HEU. HOMA-IR was higher in newborns HEU versus HUU after adjusting for confounders (mean difference of 0.068 in log HOMA-IR, P = .037). Among newborns HEU, HOMA-IR was not significantly different between TDF/XTC/DTG versus TDF/XTC/EFV in utero ARV exposure and between AZT versus NVP newborn postnatal prophylaxis arms. Conclusions. Newborns HEU versus HUU had lower insulin sensitivity at birth and at 1 month of life, raising potential concern for obesity and other metabolic perturbations later in life for newborns HEU.

Original languageEnglish (US)
Pages (from-to)2002-2009
Number of pages8
JournalJournal of Infectious Diseases
Issue number11
StatePublished - Dec 1 2022


  • in utero HIV exposure
  • insulin sensitivity
  • metabolic
  • perinatal HIV exposure

ASJC Scopus subject areas

  • Medicine(all)


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