No Effect of In Utero HIV, ART Exposure on Telomere Length During Early Life

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pregnancy ultra sound
Maternal smoking during pregnancy exerts an effect on leukocyte telomere length at birth but in utero HIV/combination antiretroviral therapy exposure does not.

Uninfected infants exposed to HIV and antiretroviral therapy in utero were shown to have leukocyte telomere lengths comparable to infants who were not exposed to HIV at birth and at 3 years of age, according to the results of a recent study published in Journal of Infectious Diseases.

Whole blood samples for HIV-exposed but uninfected (n=324) and HIV-unexposed and uninfected (n=306) children 3 years of age or younger were obtained from 3 Canadian cohort studies. Leukocyte telomere length was evaluated with monochrome multiplex quantitative polymerase chain reaction and was compared between groups.

Among the 114 HIV-exposed and 88 HIV-unexposed children with whole blood collected between 0 and 3 days after birth, leukocyte telomere length was not statistically different based on exposure status. In both groups, however, female participants had longer leukocyte telomere length at birth compared with males. Furthermore, smoking exposure in utero was associated with shorter leukocyte telomeres among HIV-exposed infants and longer leukocyte telomeres among HIV-unexposed infants.

For HIV-exposed infants at birth, duration of antiretroviral therapy exposure in utero and maternal proviral load status were not significantly associated with leukocyte telomere length. HIV-exposed infants who were exposed in utero to combination zidovudine/lamivudine/nevirapine had longer leukocyte telomeres compared with HIV-exposed infants who were exposed to zidovudine/lamivudine/ritonavir-boosted lopinavir (P =.01) and compared with HIV-unexposed infants (P =.03).

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In a subanalysis of 214 HIV-exposed infants who were age- and sex-matched with HIV-unexposed infants, no significant difference in leukocyte telomere length was noted at birth or later in infancy.

Regardless of HIV exposure status, leukocyte telomere length reduced between age 0 and 1 year before plateauing through age 3.

In an interview with Infectious Disease Advisor, Hélène Côté, PhD, associate professor in the Department of Pathology and Laboratory Medicine at the University of British Columbia in Vancouver, Canada, and lead author on the paper, concluded that the study, “found no evidence that perinatal exposure to antiretrovirals leads to telomere shortening among children born to mothers living with HIV.” She called the results “reassuring” for mothers and physicians.”


Ajaykumar A, Soudeyns H, Kakkar F, et al; CIHR Team in Cellular Aging and HIV Comorbidities in Women and Children (CARMA). Leukocyte telomere length at birth and during the early life of HIV-exposed uninfected children following in utero exposure to antiretrovirals [published online December 8, 2017]. J Infect Dis. doi: 10.1093/infdis/jix618