Metabolic and mitochondrial effects of antiretroviral drug exposure in pregnancy and postpartum: implications for fetal and future health

Antiretroviral drugs (ARVs) are indispensable in the treatment and prevention of human immunodeficiency virus infection. Although their use before, during and after pregnancy is considered safe for mother and child, there are still lingering concerns about their long-term health consequences and the ramifications of their effects on lipid, glucose, intermediary and mitochondrial metabolism. This article reviews the known effects of ARVs on macromolecular and mitochondrial metabolism as well as the potential maternal, fetal, neonatal and adult health risks associated with abnormal energy metabolism during gestation. Recommendations about enhanced monitoring for these risks in affected populations are being provided.