Piperazines

哌嗪
  • 文章类型: Journal Article
    SLC7A11是胱氨酸转运蛋白和铁凋亡抑制剂。SLC7A11的稳定性如何在响应环境胱氨酸时协调调节,E3连接酶和去泛素酶(DUB)仍然难以捉摸。这里,我们报道neddylation抑制剂MLN4924通过引起SLC7A11积累来增加胱氨酸的摄取,通过灭活Cullin-RING连接酶-3(CRL-3)。我们将KCTD10鉴定为CRL-3用于SLC7A11泛素化的底物识别亚基,和USP18作为SLC7A11去泛素酶。剥夺胱氨酸后,KCTD10或USP18的蛋白质水平降低或升高,分别,有助于SLC7A11的积累。通过使SLC7A11、KCTD10或USP18不稳定或稳定,反向调节胱氨酸摄取和铁凋亡。生物学,MLN4924与SLC7A11抑制剂咪唑酮伊拉斯汀(IKE)的组合增强了对肿瘤生长的抑制。在人类乳腺肿瘤组织中,SLC7A11水平分别与KCTD10或USP18呈负相关或正相关。总的来说,我们的研究定义了SLC7A11和铁凋亡如何由CRL3KCTD10/E3-USP18/DUB轴协调调节,并提供了合理的药物组合以增强抗癌功效的基本原理。
    SLC7A11 is a cystine transporter and ferroptosis inhibitor. How the stability of SLC7A11 is coordinately regulated in response to environmental cystine by which E3 ligase and deubiquitylase (DUB) remains elusive. Here, we report that neddylation inhibitor MLN4924 increases cystine uptake by causing SLC7A11 accumulation, via inactivating Cullin-RING ligase-3 (CRL-3). We identified KCTD10 as the substrate-recognizing subunit of CRL-3 for SLC7A11 ubiquitylation, and USP18 as SLC7A11 deubiquitylase. Upon cystine deprivation, the protein levels of KCTD10 or USP18 are decreased or increased, respectively, contributing to SLC7A11 accumulation. By destabilizing or stabilizing SLC7A11, KCTD10, or USP18 inversely regulates the cystine uptake and ferroptosis. Biologically, MLN4924 combination with SLC7A11 inhibitor Imidazole Ketone Erastin (IKE) enhanced suppression of tumor growth. In human breast tumor tissues, SLC7A11 levels were negatively or positively correlated with KCTD10 or USP18, respectively. Collectively, our study defines how SLC7A11 and ferroptosis is coordinately regulated by the CRL3KCTD10/E3-USP18/DUB axis, and provides a sound rationale of drug combination to enhance anticancer efficacy.
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  • 文章类型: Journal Article
    曲霉属由大量医学和环境相关的物种组成。按系列分类的曲霉属在环境中无处不在,包括机会性病原体sydowii曲霉,与甲癣和浅表皮肤感染有关。尽管经常有关于sydowii和相关系列Versicolores物种的临床报道,抗真菌药敏数据很少,妨碍最佳治疗选择和随后的患者结局。这里,我们采用了基于微肉汤稀释的抗真菌药敏试验(AFST)对一组155系列Versicoles菌株使用常见的抗真菌药两性霉素B,伊曲康唑,伏立康唑,泊沙康唑,伊沙武康唑和米卡芬净加入卢立康唑和奥洛芬。所有菌株均使用部分钙调蛋白基因测序进行鉴定,145个是A.sydowii,七个a.creber和三个a.versicolor,使用最新的分类学见解。总的来说,测试的抗真菌药对整个菌株集合都有效。与烟曲霉相比,一些菌株的唑类和两性霉素B的MIC略有升高。服用卢立康唑和奥洛芬后,这里第一次报道,显示出最高的体外活性,使这些抗真菌药物成为有趣的替代药物,但临床研究有必要用于未来的治疗用途。
    The genus Aspergillus consists of a vast number of medically and environmentally relevant species. Aspergillus species classified in series Versicolores are ubiquitous in the environment and include the opportunistic pathogen Aspergillus sydowii, which is associated with onychomycosis and superficial skin infections. Despite frequent clinical reports of A. sydowii and related series Versicolores species, antifungal susceptibility data are scarce, hampering optimal treatment choices and subsequent patient outcomes. Here, we employed antifungal susceptibility testing (AFST) based on microbroth dilution on a set of 155 series Versicolores strains using the common antifungals amphotericin B, itraconazole, voriconazole, posaconazole, isavuconazole and micafungin with the addition of luliconazole and olorofim. All strains were identified using partial calmodulin gene sequencing, with 145 being A. sydowii, seven A. creber and three A. versicolor, using the latest taxonomic insights. Overall, tested antifungals were potent against the entire strain collection. In comparison to A. fumigatus, azole and amphotericin B MICs were slightly elevated for some strains. AFST with luliconazole and olorofim, here reported for the first time, displayed the highest in vitro activity, making these antifungals interesting alternative drugs but clinical studies are warranted for future therapeutic use.
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  • 文章类型: Journal Article
    为了评估依从性,药物不良反应(ADR),基于dolutegr韦的抗逆转录病毒治疗的病毒学结果。
    这是一个回顾性图表回顾。
    阿巴卡利基的三级医疗机构研究,尼日利亚。
    使用随机数发生器选择了五百十五(515)名接受dolutegravir治疗的成年患者。从患者病例记录中提取人口统计学和临床数据,并使用IBM-SPSS版本25进行分析。
    坚持dolutegravir,美国存托凭证,病毒学结果,并估计体重指数(BMI)的变化。
    患者的平均年龄为45.5±10.8岁;其中68.2%为女性;其中97.1%的患者具有良好的自我报告依从性。其中大多数(82.9%)没有报告ADR,其中(17.1%)没有报告ADR,头痛(9.7%),身体瘙痒(3.1%),以皮疹(2.7%)为主。大多数实现了病毒抑制(94.4%)并且没有可检测的病毒颗粒(57.4%)。体重平均增加0.9kg的患者的BMI显著增加,BMI平均增加0.3kg/m2,超重和肥胖患病率增加2.6%.
    服用dolutegravir的患者报告不良反应较低,良好的自我报告依从性,和高病毒抑制率。然而,dolutegravir与体重增加有关。我们建议广泛使用和更多的全人群研究来阐明dolutegravir相关的体重增加。
    没有声明。
    UNASSIGNED: To assess the adherence, adverse drug reactions (ADR), and virologic outcomes of dolutegravir-based antiretroviral therapy.
    UNASSIGNED: This was a retrospective chart review.
    UNASSIGNED: A tertiary health facility-based study in Abakaliki, Nigeria.
    UNASSIGNED: Five hundred and fifteen (515) adult patients on dolutegravir were selected using a Random Number Generator. Demographic and clinical data were extracted from patients\' case notes and analysed with IBM-SPSS version-25.
    UNASSIGNED: Adherence to dolutegravir, ADRs, virologic outcome, and change in Body Mass Index (BMI) were estimated.
    UNASSIGNED: The mean age of the patients was 45.5±10.8 years; 68.2% of them were females; 97.1% of them had good self-reported adherence. The majority (82.9%) of them reported no ADRs and among those (17.1%) that did, headache (9.7%), body-itching (3.1%), and skin rash (2.7%) dominated. Most achieved viral suppression (94.4%) and did not have detectable viral particles (57.4%). There was a significant increase in the BMI of the patients with a mean weight increase of 0.9kg, a mean BMI increase of 0.3 kg/m2, and a 2.6% increase in the prevalence of overweight and obesity.
    UNASSIGNED: Patients on dolutegravir reported low ADRs, good self-reported adherence, and a high viral suppression rate. However, dolutegravir is associated with weight gain. We recommend widespread use and more population-wide studies to elucidate the dolutegravir-associated weight gain.
    UNASSIGNED: None declared.
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  • 文章类型: Journal Article
    乳腺癌,一个主要的全球健康问题,需要不断探索新的治疗策略。Palbociclib(PAL),一种众所周知的细胞周期蛋白依赖性激酶(CDK)抑制剂,在乳腺癌治疗中起着至关重要的作用。虽然它的功效得到认可,PAL和细胞自噬之间的相互作用,特别是在RAF/MEK/ERK信号通路的背景下,仍然没有充分探索。本研究使用体外(MCF7和MDA-MB-468细胞)和体内(荷瘤裸鼠)模型研究了PAL对乳腺癌的抑制作用。旨在阐明PAL对自噬过程的影响,并探索将其与曲美替尼(TRA)联合使用的潜力,MEK抑制剂,我们的研究旨在解决PAL诱导的耐药性的挑战.我们的发现表明,PAL显着降低MCF7和MDA-MB-468细胞的活力,并减少小鼠的肿瘤大小,同时在MCF10A细胞中显示出最小的细胞毒性。然而,PAL还诱导保护性自噬,可能通过RAF/MEK/ERK途径激活导致耐药性。引入TRA有效地中和了这种自噬,增强PAL的抗肿瘤功效。PAL和TRA的组合协同降低了细胞活力和增殖,体内研究显示肿瘤大小明显缩小。总之,PAL和TRA组合成为克服PAL诱导抗性的有希望的策略,为乳腺癌治疗提供了新的视野。
    Breast cancer, a predominant global health issue, requires ongoing exploration of new therapeutic strategies. Palbociclib (PAL), a well-known cyclin-dependent kinase (CDK) inhibitor, plays a critical role in breast cancer treatment. While its efficacy is recognized, the interplay between PAL and cellular autophagy, particularly in the context of the RAF/MEK/ERK signaling pathway, remains insufficiently explored. This study investigates PAL\'s inhibitory effects on breast cancer using both in vitro (MCF7 and MDA-MB-468 cells) and in vivo (tumor-bearing nude mice) models. Aimed at elucidating the impact of PAL on autophagic processes and exploring the potential of combining it with trametinib (TRA), an MEK inhibitor, our research seeks to address the challenge of PAL-induced drug resistance. Our findings reveal that PAL significantly decreases the viability of MCF7 and MDA-MB-468 cells and reduces tumor size in mice while showing minimal cytotoxicity in MCF10A cells. However, PAL also induces protective autophagy, potentially leading to drug resistance via the RAF/MEK/ERK pathway activation. Introducing TRA effectively neutralized this autophagy, enhancing PAL\'s anti-tumor efficacy. A combination of PAL and TRA synergistically reduced cell viability and proliferation, and in vivo studies showed notable tumor size reduction. In conclusion, the PAL and TRA combination emerges as a promising strategy for overcoming PAL-induced resistance, offering a new horizon in breast cancer treatment.
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  • 文章类型: English Abstract
    褪黑激素(N-乙酰基-5-甲氧基色胺,MEL)是松果体合成的激素。由于其抑癌作用,它可以被认为是一种抗肿瘤药物,并用于联合治疗。ABT-737,一种Bcl-2抑制剂,用诱导促凋亡信号的试剂处理后促进细胞死亡。在本研究中,MEL和ABT-737对增殖和有丝分裂活性变化的联合作用,线粒体膜电位,细胞内产生活性氧(ROS),研究了细胞溶质Ca^(2+)。此外,抗凋亡和促凋亡蛋白(Bcl-2和Bax)表达的变化,自噬标记(LC3A/B(I,II)),内质网应激标志物(伴侣BIP和PDI,CHOP)在这些条件下进行了研究。MEL与ABT-737一起的作用导致细胞溶质Ca^(2)水平的增加,细胞内ROS的产生和线粒体膜电位的降低。Bcl-2的含量增加,而Bax水平下降。CHOP的激活刺激自噬并导致伴侣BIP和PDI合成的减少。据推测,褪黑激素可以增强其他化学治疗剂的作用,并可用于治疗肿瘤。
    Melatonin (N-acetyl-5-methoxytryptamine, MEL) is a hormone synthesized by the pineal gland. Due to its oncostatic effect, it can be considered as an antitumor agent and used for combination therapy. ABT-737, a Bcl-2 inhibitor, promotes cell death after treatment with agents that induce pro-apoptotic signals. In the present study, the combined effect of MEL and ABT-737 on changes in proliferative and mitotic activity, mitochondrial membrane potential, intracellular production of reactive oxygen species (ROS), and cytosolic Ca^(2+) was studied. Moreover, changes in the expression of anti- and pro-apoptotic proteins (Bcl-2 and Bax), autophagy markers (LC3A/B (I, II)), endoplasmic reticulum stress markers (chaperones BIP and PDI, CHOP) were studied under these conditions. The effect of MEL together with ABT-737 led to an increase in the level of cytosolic Ca^(2+), intracellular production of ROS and a decrease in the membrane potential of mitochondria. The content of Bcl-2 increased, while the level of Bax decreased. Activation of CHOP stimulated autophagy and led to a decrease in the synthesis of chaperones BIP and PDI. It is assumed that melatonin can enhance the effect of other chemotherapeutic agents and can be used in the treatment of tumors.
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  • 文章类型: Journal Article
    肺癌是最常见和最致命的癌症之一。临床前模型对于研究考虑肿瘤遗传学的新疗法和组合至关重要。我们已经从具有不同遗传背景的细胞系中建立了表达荧光素酶基因的细胞系,常见于肺腺癌患者。我们通过测试这些品系对多种药物的反应来表征这些品系。因此,我们开发了非小细胞肺癌原位临床前小鼠模型,其移植效率非常高.这些模型可以轻松监测肿瘤的生长,特别是对治疗的反应,以及肿瘤细胞在体内的传播。我们表明,奥希替尼(第三代酪氨酸激酶抑制剂靶向突变的EGFR)和贝伐单抗(抗血管生成靶向VEGF)的联合治疗可以对EGFR突变的肿瘤产生有益的治疗效果。我们还表明,在奥希替尼治疗的肿瘤中加入阿法替尼导致肿瘤生长抑制。使用司美替尼或辛伐他汀没有观察到这种效果。因此,这些临床前小鼠模型可以测试创新的治疗组合,也是研究抗性机制的首选工具。
    Lung cancer is one of the most common and deadliest cancers. Preclinical models are essential to study new therapies and combinations taking tumor genetics into account. We have established cell lines expressing the luciferase gene from lines with varied genetic backgrounds, commonly encountered in patients with pulmonary adenocarcinoma. We have characterized these lines by testing their response to multiple drugs. Thus, we have developed orthotopic preclinical mouse models of NSCLC with very high engraftment efficiency. These models allow the easy monitoring of tumor growth, particularly in response to treatment, and of tumor cells dissemination in the body. We show that concomitant treatment with osimertinib (3rd generation tyrosine kinase inhibitor targeting mutated EGFR) and bevacizumab (anti-angiogenic targeting VEGF) can have a beneficial therapeutic effect on EGFR-mutated tumors. We also show that the addition of afatinib to osimertinib-treated tumors in escape leads to tumor growth inhibition. No such effect is observed with selumetinib or simvastatin. These preclinical mouse models therefore make it possible to test innovative therapeutic combinations and are also a tool of choice for studying resistance mechanisms.
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  • 文章类型: Letter
    暂无摘要。
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  • 文章类型: Journal Article
    背景和目标:疟疾仍然是一个重大的全球卫生挑战。在大湄公河次区域的许多地区,以青蒿素为基础的联合疗法(ACTs)的疗效有所下降,包括越南,由于耐药疟疾菌株的传播。这项研究旨在评估双氢青蒿素(DHA)-哌拉喹(PPQ)方案治疗无并发症的恶性疟疾的疗效,并在平福和大农两省进行抗疟药耐药性的分子监测。材料和方法:该研究包括63名根据WHO治疗指南(2009年)治疗的治疗效果研究(TES)的无并发症的恶性疟疾患者。对所有63例患者进行分子标志物分析。方法包括pfK13突变的Sanger测序和pfpm2基因的定量实时PCR。结果:本研究发现DHA-PPQ方案的疗效明显降低,两个研究地点的治疗失败率增加。遗传分析显示pfK13突变和pfpm2扩增的显著存在,表明对青蒿素及其伙伴药物的耐药性正在出现。结论:标准DHA-PPQ方案的有效性急剧下降,治疗失败率上升。这种下降需要审查和可能修订国家疟疾治疗指南。重要的是,分子监测和临床疗效评估共同为了解和解决疟疾耐药性检测提供了一个强有力的框架.
    Background and Objectives: Malaria continues to be a significant global health challenge. The efficacy of artemisinin-based combination therapies (ACTs) has declined in many parts of the Greater Mekong Subregion, including Vietnam, due to the spread of resistant malaria strains. This study was conducted to assess the efficacy of the Dihydroartemisinin (DHA)-Piperaquine (PPQ) regimen in treating uncomplicated falciparum malaria and to conduct molecular surveillance of antimalarial drug resistance in Binh Phuoc and Dak Nong provinces. Materials and Methods: The study included 63 uncomplicated malaria falciparum patients from therapeutic efficacy studies (TES) treated following the WHO treatment guidelines (2009). Molecular marker analysis was performed on all 63 patients. Methods encompassed Sanger sequencing for pfK13 mutations and quantitative real-time PCR for the pfpm2 gene. Results: This study found a marked decrease in the efficacy of the DHA-PPQ regimen, with an increased rate of treatment failures at two study sites. Genetic analysis revealed a significant presence of pfK13 mutations and pfpm2 amplifications, indicating emerging resistance to artemisinin and its partner drug. Conclusions: The effectiveness of the standard DHA-PPQ regimen has sharply declined, with rising treatment failure rates. This decline necessitates a review and possible revision of national malaria treatment guidelines. Importantly, molecular monitoring and clinical efficacy assessments together provide a robust framework for understanding and addressing detection drug resistance in malaria.
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  • 文章类型: Journal Article
    BUB1在大多数人类实体癌中过度表达,包括乳腺癌.较高的BUB1水平与不良预后相关,尤其是三阴性乳腺癌(TNBC)患者。患有TNBC的女性经常对化疗和放疗产生耐药性,这仍然是治疗TNBC的主要方法。我们先前的研究表明,BUB1激酶抑制剂(BAY1816032)可降低TNBC的肿瘤细胞增殖并显着增强放疗疗效。在这项研究中,我们评估了BAY1816032与PARP抑制剂(奥拉帕尼)的有效性,铂类药物(顺铂),和微管毒物(紫杉醇)单独或与放射疗法联合使用细胞毒性和克隆存活测定。BUB1抑制剂使BRCA1/2野生型SUM159和MDA-MB-231细胞对奥拉帕尼敏感,顺铂,和紫杉醇协同作用(组合指数;CI<1)。BAY1816032显著增加了奥拉帕尼对SUM159和MDA-MB-231的辐射敏感性,顺铂,或无毒浓度的紫杉醇(剂量远低于IC50浓度)。重要的是,BUB1的小分子抑制剂协同作用(CI<1)使BRCA突变体TNBC细胞系HCC1937对奥拉帕尼敏感。此外,与单独使用任何一种药物(BUB1irER1.19;PARPirER1.04)相比,BUB1抑制剂显着增加了HCC1937细胞中的放射增强率(rER1.34)。这里提供的数据是重要的,因为它们证明了抑制BUB1激酶活性会使TNBC细胞系对PARP抑制剂和辐射敏感,与BRCA1/2突变状态无关。由于BUB1抑制剂使TNBC对不同类别的药物(铂,PARPi,微管去极化抑制剂),这项工作有力地支持了BUB1作为一种新的分子靶标在TNBC中改善化学放射疗效的作用,并为BAY1816032作为化学增敏剂和化学放射增敏剂在TNBC中的临床评价提供了理论基础.
    BUB1 is overexpressed in most human solid cancers, including breast cancer. Higher BUB1 levels are associated with a poor prognosis, especially in patients with triple-negative breast cancer (TNBC). Women with TNBC often develop resistance to chemotherapy and radiotherapy, which are still the mainstay of treatment for TNBC. Our previous studies demonstrated that a BUB1 kinase inhibitor (BAY1816032) reduced tumor cell proliferation and significantly enhanced radiotherapy efficacy in TNBC. In this study, we evaluated the effectiveness of BAY1816032 with a PARP inhibitor (olaparib), platinum agent (cisplatin), and microtubule poison (paclitaxel) alone or in combination with radiotherapy using cytotoxicity and clonogenic survival assays. BUB1 inhibitors sensitized BRCA1/2 wild-type SUM159 and MDA-MB-231 cells to olaparib, cisplatin, and paclitaxel synergistically (combination index; CI < 1). BAY1816032 significantly increased the radiation sensitization of SUM159 and MDA-MB-231 by olaparib, cisplatin, or paclitaxel at non-toxic concentrations (doses well below the IC50 concentrations). Importantly, the small molecular inhibitor of BUB1 synergistically (CI < 1) sensitized the BRCA mutant TNBC cell line HCC1937 to olaparib. Furthermore, the BUB1 inhibitor significantly increased the radiation enhancement ratio (rER) in HCC1937 cells (rER 1.34) compared to either agent alone (BUB1i rER 1.19; PARPi rER 1.04). The data presented here are significant as they provide proof that inhibition of BUB1 kinase activity sensitizes TNBC cell lines to a PARP inhibitor and radiation, irrespective of BRCA1/2 mutation status. Due to the ability of the BUB1 inhibitor to sensitize TNBC to different classes of drugs (platinum, PARPi, microtubule depolarization inhibitors), this work strongly supports the role of BUB1 as a novel molecular target to improve chemoradiation efficacy in TNBC and provides a rationale for the clinical evaluation of BAY1816032 as a chemosensitizer and chemoradiosensitizer in TNBC.
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  • 文章类型: Journal Article
    背景:在怀孕之外,有证据表明,与接受其他ART治疗的患者相比,开始或转换为基于dolutegravir(DTG)的抗逆转录病毒治疗(ART)患者的体重增加更大.然而,在艾滋病毒最常见的撒哈拉以南非洲,关于基于DTG的ART对妊娠期体重增加(GWG)的影响的数据很少.根据美国国家医学科学院(NAM),低于和高于NAM指南的GWG与不良分娩结局相关。因此,这项研究的目的是通过HIV状况和ART方案描述GWG,并检查与不良分娩结局的关联。
    方法:我们在开普敦的城市周边初级医疗机构招募了感染艾滋病毒(WHIV)和未感染艾滋病毒(≥18岁)的孕妇,南非在2019年至2022年之间。根据NAM指南,在妊娠24-28(基线)和33-38周时对GWG进行研究测量,并转换为GWG率(kg/周)。使用INTEGROWTH-21和美国标准产生GWGz评分,以考虑不同的妊娠长度。出生结果数据来自医疗记录。使用多变量线性或对数二项回归评估GWGz评分与不良出生结局的关联。
    结果:在292名参与者(48%WHIV)中,中位年龄为29岁(IQR,25-33),中位孕前体重指数(BMI)为31kg/m2(IQR,26-36)和20%是基线时的初产。GWG的每周中位数为0.30千克/周(IQR,0.12-0.50),35%的GWG低于NAM标准(59%WHIV),48%的GWG高于NAM标准(36%WHIV)。WHIV体重增加更慢(0.25vs.0.37公斤/周,p<0.01)比没有艾滋病毒的妇女。GWG的每周比率因ART方案而没有差异(基于DTG的ART0.25与基于efavirenz的ART0.27公斤/周,p=0.80)。在多变量分析中,GWGz评分与连续出生体重(平均差异=68.5395%CI8.96,128.10)和分类高出生体重>4000g(RR=2.1895%CI1.18,4.01)呈正相关。
    结论:尽管WHIV中GWG较慢,近一半的女性体重增加速度比NAM建议的要快。GWG与婴儿出生体重呈正相关。迫切需要采取干预措施,以支持撒哈拉以南非洲的健康GWG。
    BACKGROUND: Outside of pregnancy, evidence shows that persons with HIV initiating or switching to dolutegravir (DTG)-based antiretroviral therapy (ART) experience greater weight gain compared to those on other ART classes. However, there are few data on the impact of DTG-based ART on gestational weight gain (GWG) in sub-Saharan Africa where HIV is most common. According to the National Academy of Medicine (NAM), GWG below and above NAM guidelines is associated with adverse birth outcomes. Therefore, the objective of this study was to describe GWG by HIV status and ART regimen, and examine the associations with adverse birth outcomes.
    METHODS: We enrolled pregnant women with HIV (WHIV) and without HIV (≥18 years) in a peri-urban primary healthcare facility in Cape Town, South Africa between 2019 and 2022. GWG was study-measured at 24-28 (baseline) and 33-38 weeks gestation and converted to GWG rate (kg/week) in accordance with NAM guidelines. GWG z-scores were generated using the INTEGROWTH-21 and US standards to account for differing lengths of gestation. Birth outcome data were obtained from medical records. Associations of GWG z-score with adverse birth outcomes were assessed using multivariable linear or log-binomial regression.
    RESULTS: Among 292 participants (48% WHIV), median age was 29 years (IQR, 25-33), median pre-pregnancy body mass index (BMI) was 31 kg/m2 (IQR, 26-36) and 20% were primiparous at baseline. The median weekly rate of GWG was 0.30 kg/week (IQR, 0.12-0.50), 35% had GWG below NAM standards (59% WHIV) and 48% had GWG above NAM standards (36% WHIV). WHIV gained weight more slowly (0.25 vs. 0.37 kg/week, p<0.01) than women without HIV. Weekly rate of GWG did not differ by ART regimen (DTG-based ART 0.25 vs. efavirenz-based ART 0.27 kg/week, p = 0.80). In multivariable analyses, GWG z-score was positively associated with continuous birth weight (mean difference = 68.53 95% CI 8.96, 128.10) and categorical high birth weight of >4000 g (RR = 2.18 95% CI 1.18, 4.01).
    CONCLUSIONS: Despite slower GWG among WHIV, nearly half of all women gained weight faster than recommended by the NAM. GWG was positively associated with infant birth weight. Interventions to support healthy GWG in sub-Saharan Africa are urgently needed.
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