{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:17:00Z","timestamp":1777972620587,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002879","name":"Canadian HIV Trials Network, Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002879","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020951","name":"Fonds de recherche du Qu\u00e9bec","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020951","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Integrase strand transfer inhibitors (INSTIs) are first\u2010line antiretroviral medications used in pregnancy. Pre\u2010clinical research suggests adverse effects in human stem cells associated with second\u2010 versus first\u2010generation INSTIs. We compared perinatal and early infant outcomes after exposure to first\u2010 versus second\u2010generation INSTIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were taken from the Canadian Perinatal HIV Surveillance Program. Infants born between January 1, 2010, and December 31, 2023, with in utero INSTI exposure were included. Univariate analysis compared perinatal and early infant outcomes between first\u2010 and second\u2010generation INSTI exposures. Multivariable logistic regression was completed to identify independent associations between INSTI class and perinatal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1160 infants were included: 433 exposed to first\u2010generation INSTIs and 727 to second\u2010generation. There was a non\u2010significant finding of fewer small\u2010for\u2010gestational\u2010age (SGA) infants with exposure to second\u2010generation INSTIs (odds ratio [OR]\u2009=\u20090.75; 95% confidence interval [CI]\u2009=\u20090.55\u20131.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.058), which remained non\u2010significant in multivariable analysis (OR\u2009=\u20090.72, 95% CI\u2009=\u20090.49\u20131.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.105). There was a non\u2010significant finding of increased preterm births with exposure to second\u2010generation INSTIs (OR\u2009=\u20091.40, 95% CI\u2009=\u20090.97\u20132.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.070), which remained non\u2010significant in multivariable analyses (OR\u2009=\u20091.01, 95% CI\u2009=\u20090.62\u20131.66,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.962). There was a non\u2010significant increase in infant deaths in the second\u2010generation INSTI group compared to the first\u2010generation group (6 vs. 0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.089). No differences were observed in HIV transmission (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.208).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There were no significant associations between second\u2010generation INSTIs and adverse perinatal outcomes compared to first\u2010generation INSTIs. These findings support the ongoing use of second\u2010generation INSTIs in pregnancy with continued careful surveillance of perinatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hiv.70206","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:10:06Z","timestamp":1770786606000},"page":"761-770","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perinatal and early infant outcomes after first\u2010versus second\u2010generation integrase strand transfer inhibitor use in pregnancy"],"prefix":"10.1111","volume":"27","author":[{"given":"Rosa","family":"Balleny","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9164-3383","authenticated-orcid":false,"given":"Jeffrey Man Hay","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry","family":"Lee","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari","family":"Bitnun","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Boucoiran","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Brophy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Ottawa  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannette","family":"Comeau","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatima","family":"Kakkar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Universit\u00e9 de Montr\u00e9al  Montr\u00e9al Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athena","family":"McConnell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Sauv\u00e9","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Singer","sequence":"additional","affiliation":[{"name":"CIHR Pan\u2010Canadian Network for HIV and STBBI Clinical Trials Research  Montr\u00e9al Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alena","family":"Tse\u2010Chang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alberta  Edmonton Saskatchewan Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Money","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach","author":"World Health Organization","year":"2021"},{"key":"e_1_2_11_3_1","volume-title":"Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States","author":"Department of Health and Human Services. Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission","year":"2024"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiac386"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12977-022-00608-1"},{"key":"e_1_2_11_6_1","volume-title":"Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV","author":"Department of Health and Human Services. 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