Adverse effects in children exposed to maternal HIV and antiretroviral therapy during pregnancy in Brazil: a cohort study

Abstract

BackgroundAntiretroviral therapy (ART) in pregnancy was associated with a drastic reduction in HIV mother-to-child transmission (MTCT), although it was associated with neonatal adverse effects. The aim of this study was to evaluate the neonatal effects to maternal ART.MethodsThis study was a cohort of newborns from HIV pregnant women followed at the CAISM/UNICAMP Obstetric Clinic from 2000 to 2015. The following adverse effects were evaluated: anemia, thrombocytopenia, liver function tests abnormalities, preterm birth, low birth weight and congenital malformation. Data collected from patients’ files was added to a specific database. Descriptive analysis was shown in terms of absolute (n) and relative (%) frequencies and mean, median and standard deviation calculations. The association between variables was tested through Chi-square or Fisher exact test (n < 5) and relative risk (RR) with its respective p values for the categorical ones and t-Student (parametric data) or Mann-Whitney (non-parametric data) for the quantitative ones. The significant level used was 0.05. A multivariate Cox Logistic Regression was done. Statistical analysis was performed using SAS version 9.4.ResultsData from 787 newborns was analyzed. MTCT rate was 2.3%, with 0.8% in the last 5 years. Observed neonatal adverse effects were: liver function tests abnormalities (36%), anemia (25.7%), low birth weight (22.5%), preterm birth (21.7%), children small for gestational age (SGA) (18%), birth defects (10%) and thrombocytopenia (3.6%). In the multivariate analysis, peripartum CD4 higher than 200 cells/mm3 was protective for low birth weight and preterm birth, and C-section was associated with low birth weight, but not with preterm birth. Neonatal anemia was associated with preterm birth and exposure to maternal AZT. Liver function tests abnormalities were associated with detectable peripartum maternal viral load and exposure to nevirapine. No association was found between different ART regimens or timing of exposure with preterm birth, low birth weight or congenital malformation.ConclusionHighly active antiretroviral treatment in pregnant women and viral load control were the main factors associated with MTCT reduction. Antiretroviral use is associated with a high frequency but mainly low severity adverse effects in newborns.

Severe haematologic toxicity is rare in high risk HIV‐exposed infants receiving combination neonatal prophylaxis

“…In the Spanish study, comparing two periods of exposure (2000–2001 and 2007–2013), the authors reported a lower incidence of anaemia and neutropaenia in the second period, with a higher frequency of adverse effects when using maternal regimens containing ZDV . Similar results were reported in a recent Brazilian study including 787 HIV‐exposed newborns, 25% of them presenting with anaemia at birth . An increased risk of anaemia was associated with exposure to maternal regimens containing ZDV (compared with tenovofir) and with preterm birth .…”

Characteristics of HIV-positive pregnant women and HIV- and antiretroviral therapy-exposed fetuses: A case-control study

“…Regarding the SGA rate, HIV infection itself and ART both contributed to a higher SGA rate [11,19]. Among the ART regimens, one mouse-based model revealed that PI will affect the IUFG by decreasing the progesterone level, which leads to fetal growth restriction [14].…”

Adverse effects of antiretroviral therapy in pregnant women infected with HIV in Brazil from 2000 to 2015: a cohort study

“…Regarding birth outcomes, the authors used the same pregnant women’s cohort and their newborns to analyze neonatal adverse effects such as prematurity, low birth weight, small for gestational age week, neonatal anemia and hepatic alterations. The results on birth outcomes are described in another article which has just been published [ 55 ].…”

“…The high Caesarian section rate in this cohort occurred because from 2005 to 2015 most of pregnant women infected with HIV delivered by C-section following changes in the service’s protocol after the European Collaborative Group published their study [ 56 ]. On the other hand, prematurity was not considered iatrogenic and was not associated with C-section as shown in the recently published article by the same authors [ 55 ].…”