Exposure to Antiretroviral Therapy in Utero or Early Life: the Health of Uninfected Children Born to HIV-Infected Women

Hankin, Claire; Thorne, C; Peckham, Catherine; Newell, Marie‐Louise; Scherpbier, H. J.; Kreyenbroek, M.; Boer, Kees

doi:10.1097/00126334-200304010-00006

Cited by 196 publications

(30 citation statements)

References 29 publications

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“…A review of 5 US cohorts (combined population of over 10,000 children exposed to NRTIs) also found no indication that perinatal ARV exposure was associated with death from mitochondrial dysfunction or from sudden infant death syndrome [54]. A later analysis of the data from the European Collaborative Study, which included 1008 infants exposed to ART perinatally (ZDV therapy was the most common neonatal regimen), also found no association of NRTI exposure with clinical manifestations suggestive of mitochondrial dysfunction [55]. …”

Section: Safety Of Arv Used As Neonatal and Infant Prophylaxismentioning

confidence: 99%

Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis

Hurst

Appelgren

Kourtis³

2015

Expert Review of Anti-infective Therapy

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Summary The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT. In this paper, we focus on the role of neonatal and infant prophylaxis, discuss mechanisms of protection, and present the clinical trial-generated evidence that led to the current recommendations for preventing infections in breastfed and nonbreastfed infants. PMTCT of HIV should not end at birth; a continuum of care extending postpartum and postnatally is required to minimize the risk of new pediatric HIV infections.

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Section: Safety Of Arv Used As Neonatal and Infant Prophylaxismentioning

confidence: 99%

Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis

Hurst

Appelgren

Kourtis³

2015

Expert Review of Anti-infective Therapy

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“…Considerable data link protease inhibitors to preterm delivery and low birth-weight. [31-33]. Hematologic abnormalities may also be associated with exposure to ARV’s; both short and long term effects on several hematologic parameters have been noted in infants exposed in utero and post-natally to different ARV’s.…”

Section: Long-term Impact Of Hiv Exposure On Infant and Childhoodmentioning

confidence: 99%

HIV-exposed infants

Sugandhi

Rodrigues

Kim

et al. 2013

Aids

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Summary Each year over a million infants are born to HIV infected mothers though with scale up of prevention of mother to child transmission (PMTCT) interventions, only 210,000 of the 1.3 million infants born to mothers with HIV/AIDS in 2012 became infected. Current programmatic efforts directed at infants born to HIV-infected mothers are primarily focused on decreasing their risk of infection, but this emphasis on maternal interventions has meant follow-up of exposed infants has been poor. Programs are struggling to retain this population in care until the end of exposure, typically at the cessation of breastfeeding, between 12 and 24 months of age. But HIV exposure is a life-long condition that continues to impact the health and well-being of a child long after exposure has ended. A better understanding of the impact of HIV on exposed infants is needed and new programs and interventions must take into consideration the long-term health needs of this growing population. The introduction of lifelong treatment for all HIV-infected pregnant women is an opportunity to rethink how we provide services adapted for the long-term retention of mother-infant pairs.

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“…1, 2 Some epidemiologic studies have indicated that maternal ARV use during pregnancy may be associated with significant increases in adverse pregnancy outcomes, 3-10 including small for gestational age (SGA), 7, 10 but the evidence remains inconclusive as other studies did not observe such associations. 5, 11-15 The conflicting evidence regarding SGA may be due to differences in the definition of SGA or ARV comparison groups between studies; also, comparison of SGA risk by ARV drug class has not been adequately explored. Our study used a variety of exposure classifications, including classification by drug class, to evaluate the effect of ARV use during pregnancy on the risk of SGA in the newborn (using the standard definition of birth weight below the 10 th percentile for gestational age) among HIV-infected pregnant women in the US.…”

mentioning

confidence: 99%

Antiretroviral Therapy Use During Pregnancy and the Risk of Small for Gestational Age Birth in a Medicaid Population

Phiri¹,

Williams

Dugan³

et al. 2015

Pediatric Infectious Disease Journal

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Background Several studies have assessed the association between antiretroviral (ARV) therapy use during pregnancy and small for gestational age (SGA), but the evidence remains incompletely elucidated. Methods We linked data from Tennessee Medicaid files and vital records to evaluate pregnancies among human immunodeficiency virus (HIV)-infected women who delivered between 1994 and 2009.Maternal HIV status was defined based on diagnosis codes, ARV prescriptions, and laboratory codes for CD4 count or HIV RNA assays. ARV use was identified from pharmacy claims. Risk of SGA (defined as birthweight below the 10th percentile for gestational age) and preterm birth were evaluated using logistic regression models. Results 477 HIV- infected pregnant women contributing 604 singleton pregnancies were identified; 156 (26%) delivered SGA infants. ARV use during pregnancy was not associated with SGA (adjusted odds ratio [aOR] = 0.93; 95% confidence interval [CI], 0.56-1.56) or preterm birth (aOR = 0.74; 95% CI, 0.42-1.32). Exposure to a protease inhibitor (PI) during the first trimester was associated with a lower risk of SGA (OR, 0.54; 95% CI, 0.29-1.01) compared to non-exposure to a PI throughout pregnancy. Conclusions We observed no evidence of an association between ARV exposure during pregnancy and SGA delivery in this Medicaid cohort of HIV-infected women.

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Exposure to Antiretroviral Therapy in Utero or Early Life: the Health of Uninfected Children Born to HIV-Infected Women

Cited by 196 publications

References 29 publications

Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis

Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis

HIV-exposed infants

Antiretroviral Therapy Use During Pregnancy and the Risk of Small for Gestational Age Birth in a Medicaid Population

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