Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Nlend, Anne Esther Njom; Motaze, Annie Nga; Tetang, Suzie Moyo; Zeudja, Cécile; Ngantcha, Marcus; Tejiokem, Mathurin Cyrille

doi:10.1371/journal.pone.0150565

Cited by 15 publications

(9 citation statements)

References 29 publications

(38 reference statements)

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“…EFV‐based regimens have demonstrated a null or protective relationship with preterm birth when compared to nevirapine‐ or dolutegravir‐based regimens and are widely available. Among infants in our study, birth outcomes were comparable to or more favourable than results from other sub‐Saharan African countries for both preterm birth and low birth weight . We did not observe pregnancy outcomes for women lost to follow‐up, so our results may underestimate adverse birth outcomes and MTCT events.…”

Section: Discussionsupporting

confidence: 56%

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Harrington

DiPrete

Jumbe

et al. 2019

Tropical Med Int Health

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Objectives Malawi's Option B+ universal antiretroviral therapy (ART) program for pregnant and breastfeeding women does not include routine laboratory monitoring. We report safety outcomes of pregnant women who initiated ART through Option B+. Methods We analysed 12‐month data from an observational cohort study on Option B+ among women newly initiating tenofovir/lamivudine/efavirenz (TDF/3TC/EFV) at a government antenatal clinic in Lilongwe, Malawi. Proportions of women engaged in care, incidence of DAIDS grade ≥ 2 laboratory toxicity, grade ≥ 3 adverse events (AEs), viral suppression (<1000 copies/mL), birth outcomes and infant HIV infections are reported. Results At ART initiation, participants (n = 299) had a median age of 26 years (IQR 22–30), median CD4 count of 352 cells/μl (IQR 231–520) and 94% were in WHO Stage 1. We noted 76 incident DAIDS Grade ≥ 2 laboratory results among 58 women, most commonly elevated liver function tests (n = 30 events) and low haemoglobin (n = 27). No women had elevated creatinine. Clinical AEs (n = 45) were predominantly infectious diseases and Grade 3. Five participants (2%) discontinued TDF/3TC/EFV due to virologic failure (3) or toxicity (2). Twelve months after ART initiation, most women were engaged in care (89%) and had HIV RNA < 1000 copies/ml (90%). 8% of pregnancies resulted in preterm birth, 9% were low birthweight (<2500 g), and 2% resulted in infant HIV infection at 6 weeks post‐delivery. Conclusion Most women remained on ART and were virally suppressed 12 months after starting Option B+. Few infants contracted HIV perinatally. While some women experienced adverse laboratory events, clinical symptom monitoring is likely reasonable.

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Section: Discussionsupporting

confidence: 56%

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Harrington

DiPrete

Jumbe

et al. 2019

Tropical Med Int Health

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“…In our study, we found an association between maternal plasma levels of sCD14 during the second half of pregnancy and low neonatal birthweight. This association persisted ( P = .043) in a multivariate regression model adjusted for demographic and clinical characteristics known to be potential risk factors for low birthweight . To our knowledge, this is the first time that this association is observed in low‐income countries, where the role of systemic immune activation markers may be confounded by other factors, such as malnutrition and maternal comorbidities, including opportunistic infections and/or vector transmissible diseases.…”

Section: Discussionmentioning

confidence: 64%

“…The association between maternal levels of sCD14 and birthweight was tested using a multivariable linear regression model, controlling for potential confounding factors. The selection of potential confounding variables, including both demographic and clinical characteristics, was based on previous data and the available information in this study. Differences were considered statistically significant when P < .05.…”

Section: Methodsmentioning

confidence: 99%

Soluble CD14 levels in plasma and breastmilk of Malawian HIV+ women: Lack of association with morbidity and mortality in their exposed infants

Baroncelli

Galluzzo

Liotta

et al. 2018

American J Rep Immunol

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“…It is possible that our sample size did not enable detection of small to moderate differences between these groups of women, however our results are consistent with findings from a previous South African cohort, 21 and findings from other settings. 35 This suggests that in our study population there might be minimal differences across the comparison group and that any GA measurement errors were equally distributed.…”

Section: Discussionmentioning

confidence: 80%

Methods of gestational age assessment influence the observed association between antiretroviral therapy exposure, preterm delivery, and small-for-gestational age infants: a prospective study in Cape Town, South Africa

Malaba

Newell

Madlala

et al. 2018

Annals of Epidemiology

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Purpose Heterogeneous findings exist on antiretroviral treatment (ART) use in pregnancy and preterm delivery (PTD) or infants born small-for-gestational age (SGA). Whether reported differences may be explained by methods used to ascertain gestational age(GA) has not been explored. Methods We enrolled consecutive pregnant women attending a large primary care antenatal clinic in South Africa. Public-sector midwives assessed GA by last menstrual period (LMP) and symphysis-fundal height (SFH). Separately, if clinical GA was <24weeks, ultrasound (US) was performed by a research sonographer blinded to midwife assessments. In analysis, the impact of measurement error on the association between HIV/ART status and birth outcome by GA method was assessed, and factors associated with clinical GA under- or over-estimation identified. Results In 1787 women included overall, estimated PTD incidence was 36% by LMP, 17% by SFH and 11% by US. PTD risk was higher for HIV-infected than HIV-uninfected women using US-GA (adjusted odds ratio (aOR) 1.95; 95% CI 1.10–3.46); for LMP/SFH-GA the associations were smaller and not significant. These findings persisted after adjustment for age, parity, height and previous PTD. PTD risk did not vary by timing of ART initiation (before or during pregnancy) for any method. Elevated BMI and older age were associated with decreased risk of under-estimation by both LMP and SFH; HIV status and obesity were associated with increased risk of over-estimation by SFH. There were no differences in SGA incidence across GA methods. Conclusions Findings for an association between HIV/ART and birth outcomes are substantially influenced by GA assessment method. With growing public health interest in this association, future research efforts should seek to standardize optimal measures of gestation.

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Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon

Cited by 15 publications

References 29 publications

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Soluble CD14 levels in plasma and breastmilk of Malawian HIV+ women: Lack of association with morbidity and mortality in their exposed infants

Methods of gestational age assessment influence the observed association between antiretroviral therapy exposure, preterm delivery, and small-for-gestational age infants: a prospective study in Cape Town, South Africa

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