Infant outcomes after maternal antiretroviral exposure in resource-limited settings
Nielsen-Saines, K.; Komarow, L.; Cu-Uvin, S.; Jourdain, G.; Klingman, K.L.; Shapiro, D.E.; Mofenson, L.; Moran, L.; Campbell, T.B.; Hitti, J.; Fiscus, S.; Currier, J.; Hudgens, K.; Acosta, E.; Eshleman, S.; Fiscus, S.; Martinez, A.; Kidd-Freeman, L.; Nair, A.; Stevens, L.M.; Walawander, A.; Gormley, J.; Vincent, C.A.; Shugarts, D.L.; Cooper, M.; Siminski, S.; Brizz, B.; Chokephaibulkit, K.; Vanprapar, N.; Kumarasamy, N.; Poongulali, S.; Layangool, P.; Mekmullica, J.; Sirisanthana, V.; Puthanakit
Pediatrics 129(6): E1525-E1532
2012
ISSN/ISBN: 1098-4275 PMID: 22585772 DOI: 10.1542/peds.2011-2340Document Number: 564826
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 were seen in 18 (7.6%) infants, of which 17 were Thai (11%: 95% CI, 6.7%-17.0%); none had first trimester ARV exposure. Infant follow-up in large international cohorts is feasible and provides important safety and HIV transmission data following maternal ARV exposure. Increased surveillance increases identification of congenital/inborn errors.