Infant outcomes after maternal antiretroviral exposure in resource-limited settings.

Pediatrics
Karin Nielsen-SainesACTG 5190/PACTG 1054 Study Team

Abstract

The impact of maternal antiretrovirals (ARVs) during pregnancy, labor, and postpartum on infant outcomes is unclear. Infants born to HIV-infected mothers in ARV studies were followed for 18 months. Between June 2006 and December 2008, 236 infants enrolled from Africa (n = 36), India (n = 47), Thailand (n = 152), and Brazil (n = 1). Exposure to ARVs in pregnancy included ≥ 3 ARVs (10%), zidovudine/intrapartum ARV (81%), and intrapartum ARV (9%). There were 4 infant infections (1 in utero, 3 late postpartum) and 4 deaths with 1.8% mortality (95% confidence interval [CI], 0.1%-3.5%) and 96.4% HIV-1-free survival (95% CI, 94.0%-98.9%). Birth weight was ≥ 2.5 kg in 86%. In the first 6 months, Indian infants (nonbreastfed) had lowest median weights and lengths and smallest increases in growth. After 6 months, African infants had the lowest median weight and weight-for-age z scores. Infants exposed to highest maternal viral load had the lowest height and height-for-age z scores. Serious adverse events occurred in 38% of infants, did not differ by country, and correlated with less maternal ARV exposure. Clinical diagnoses were seen in 84% of Thai, 31% of African, and 9% of Indian infants. Congenital defects/inborn errors of metabolism ...Continue Reading

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Citations

Oct 4, 2012·Current Opinion in HIV and AIDS·Lynn T MatthewsDeborah Cohan
Jan 1, 2014·The Pediatric Infectious Disease Journal·Jennifer Jao, Elaine J Abrams
May 17, 2015·HIV Clinical Trials·Cynthia FirnhaberThomas B Campbell
May 11, 2016·The Pediatric Infectious Disease Journal·Kristina AdachiUNKNOWN NICHD HPTN 040 Study Team
Oct 16, 2016·Journal of the International AIDS Society·Jennifer JaoElaine J Abrams
Dec 26, 2017·Frontiers in Cellular and Infection Microbiology·Rahul MittalXue Zhong Liu

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