Common occurrence of anaemia at the end of pregnancy following exposure to zidovudine-free regimens

Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding

“…Several randomized trials and cohort studies have demonstrated adverse effects of antiretrovirals on maternal or infant iron status, particularly zidovudine-containing regimens; 9,14,16,36-45 however, none, other than ours, 17 evaluated extended postnatal ARV regimens coupled with a nutritional supplement. Furthermore, none of these trials evaluated multiple iron status indicators, nor did they account for the effect of inflammation and infection on iron status.…”

“…9 Another cohort study in Italy compared hematologic outcomes of antiretrovirals in three groups 1) women receiving zidovudine-based HAART from conception, 2) women starting zidovudine-based HAART during pregnancy, and 3) women receiving zidovudine-free HAART from conception. 36 Women receiving zidovudine-free HAART had a greater decrease in Hb from baseline to 36 weeks gestation compared to women who started a zidovudine-containing HAART regimen during pregnancy (-20.3 ± 11.9 g/L vs. -13.6 ± 12.0 g/L, p=0.04). 36 Together these studies suggest that prenatal maternal Hb may be compromised by some ARV regimens, but there is insufficient evidence that prenatal ARVs always lead to anemia.…”

“…36 Women receiving zidovudine-free HAART had a greater decrease in Hb from baseline to 36 weeks gestation compared to women who started a zidovudine-containing HAART regimen during pregnancy (-20.3 ± 11.9 g/L vs. -13.6 ± 12.0 g/L, p=0.04). 36 Together these studies suggest that prenatal maternal Hb may be compromised by some ARV regimens, but there is insufficient evidence that prenatal ARVs always lead to anemia. We did not observe sustained adverse effects of postpartum ARVs on maternal Hb.…”

“…36 In a Tanzanian cohort of ARV-naive and predominately anemic HIV-infected women who received standard iron and folic acid supplementation during pregnancy (containing 120 mg iron and 5 mg folic acid), maternal multivitamin supplementation, containing no iron, starting prenatally and continuing through lactation was associated with 8.8 g/L (p=0.0002) higher maternal hemoglobin (Hb) at ≤70 days postpartum compared to placebo. 47 The authors speculated that vitamins in the supplement, especially vitamin C, may have contributed to better iron status and enhanced absorption of dietary iron.…”

Antiretroviral Treatment Is Associated With Iron Deficiency in HIV-Infected Malawian Women That Is Mitigated With Supplementation, but Is Not Associated With Infant Iron Deficiency During 24 Weeks of Exclusive Breastfeeding

“…iron stores are depleted); therefore, populations can have depleted iron stores before tissue iron depletion is apparent. Maternal supplementation had few clinically meaningful or sustained effects on infant TfR, Hb or ferritin, and neither the mLNS nor maternal or infant ARVs were associated with increased risk of infant iron deficiency or anemia at 24 weeks.. Several randomized trials and cohort studies have demonstrated adverse effects of antiretrovirals on maternal or infant iron status, particularly zidovudine-containing regimens; 9,14,16,[36][37][38][39][40][41][42][43][44][45] however, none, other than ours, 17 evaluated extended postnatal ARV regimens coupled with a nutritional supplement. Furthermore, none of these trials evaluated multiple iron status indicators, nor did they account for the effect of inflammation and infection on iron status.…”