1. Infant outcomes after maternal antiretroviral exposure in resource-limited settings.
- Author
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Nielsen-Saines K, Komarow L, Cu-Uvin S, Jourdain G, Klingman KL, Shapiro DE, Mofenson L, Moran L, Campbell TB, Hitti J, Fiscus S, and Currier J
- Subjects
- Cohort Studies, Developing Countries economics, Female, Follow-Up Studies, HIV Infections drug therapy, HIV Infections economics, Humans, Infant, Internationality, Pregnancy, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious economics, Prospective Studies, Treatment Outcome, Viral Load, Anti-HIV Agents therapeutic use, HIV Infections epidemiology, HIV-1, Health Resources economics, Infectious Disease Transmission, Vertical economics, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious epidemiology
- Abstract
Background and Objective: The impact of maternal antiretrovirals (ARVs) during pregnancy, labor, and postpartum on infant outcomes is unclear., Methods: Infants born to HIV-infected mothers in ARV studies were followed for 18 months., Results: 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., Conclusions: 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.
- Published
- 2012
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