# Efavirenz-Based Highly Active Antiretroviral Therapy Disrupts Folliculogenesis: Evidence From 48 Women of Reproductive Age

## TL;DR

This study finds that efavirenz-based HIV treatment may harm ovarian function in women of reproductive age.

## Contribution

The study provides new evidence linking efavirenz-based ART to disrupted folliculogenesis in human females.

## Key findings

- FSH levels were significantly higher in HIV-positive women on ARVs compared to controls.
- Antral follicle counts were significantly lower in women receiving ARVs.
- LH levels were elevated in HIV-positive women on ARVs compared to HIV-negative controls.

## Abstract

Introduction: Interventions to eliminate mother-to-child transmission of HIV have led to a low vertical transmission rate and improved reproductive outcomes for women living with HIV. There are genuine concerns about the long-term effect of antiretroviral drugs (ARVs) on the future reproductive function of females, as female rodent models have shown impaired folliculogenesis when treated with contemporary ARVs. There is a need to investigate the effect of contemporary ARVs on the ovarian reserve of patients receiving ARVs.

Methods: This cross-sectional study was conducted on women between the reproductive age of 15 and 45 years, forming three study categories. Group 1 comprised HIV-positive patients already on efavirenz-based antiretroviral therapy. Group 2 comprised HIV-positive patients who were naïve to ARVs at the time of recruitment. Group 3 comprised HIV-negative women within the reproductive age range not on ARVs (controls). We used t-test and ANOVA for statistical analysis. The alpha level was significant if the p-value was <0.05.

Results: The average value of follicle-stimulating hormone was significantly higher in the HIV-positive group receiving ARVs, compared to the control group (p = 0.039). The average value of luteinizing hormone was significantly higher in the HIV-positive group receiving ARVs when compared to the HIV-negative group (p = 0.014). The antral follicular count was significantly reduced in the group receiving ARVs, compared to HIV-positive individuals naïve to ARVs and HIV-negative controls (p = 0.009).

Conclusion: Evidence from this study suggests that efavirenz-based antiretroviral medication disrupts follicular development.