Laboratory Abnormalities Among HIV-Exposed, Uninfected Infants: IMPAACT Protocol P1025

Overview

Journal J Pediatric Infect Dis Soc

Publisher Oxford University Press

Specialties Infectious Diseases
Pediatrics

Date 2013 May 21

PMID 23687574

Citations 6

Authors

Jennifer S Read

Yanling Huo

Kunjal Patel

Marcia Mitchell

Gwendolyn B Scott

Affiliations

Soon will be listed here.

Abstract

Background: Infant laboratory abnormalities have been associated with exposure to antiretrovirals and to trimethoprim/sulfamethoxazole (TMP/SMX).

Methods: We analyzed data from International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) Protocol P1025, a prospective cohort study of human immunodeficiency virus type 1 (HIV)-infected women and their infants. Live-born, singleton, HIV-uninfected infants with at least 6 months of follow-up who represented the first pregnancy on study of HIV-infected mothers with at least 1 prenatal visit, CD4 count, and viral load during pregnancy and who used at least 1 antiretroviral during pregnancy were eligible for inclusion in this analysis.

Results: The study population comprised 1524 infants. During the first 6 months of life, 7.4% of laboratory serious adverse events (SAEs) were related to glucose, 7.2% were related to hemoglobin, 8.7% were related to absolute neutrophil count, and 4.0% were related to total lymphocyte count. The likelihood of laboratory SAEs decreased with increasing age for hemoglobin, absolute neutrophil count, and glucose. Infant preterm birth and current receipt of antiretroviral(s) were the factors with the strongest associations with laboratory SAEs.

Conclusions: The overall frequency of laboratory SAEs was low and decreased with age. Preterm infants are at higher risk of hemoglobin- and total lymphocyte count-related SAEs.

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References

Ravizza M, Martinelli P, Bucceri A, Fiore S, Alberico S, Tamburrini E . Treatment with protease inhibitors and coinfection with hepatitis C virus are independent predictors of preterm delivery in HIV-infected pregnant women. J Infect Dis. 2007; 195(6):913-4. DOI: 10.1086/507045. View

Hanson I, Antonelli T, Sperling R, Oleske J, Cooper E, Culnane M . Lack of tumors in infants with perinatal HIV-1 exposure and fetal/neonatal exposure to zidovudine. J Acquir Immune Defic Syndr Hum Retrovirol. 1999; 20(5):463-7. DOI: 10.1097/00042560-199904150-00008. View

Hankin C, Lyall H, Peckham C, Tookey P . Monitoring death and cancer in children born to HIV-infected women in England and Wales: use of HIV surveillance and national routine data. AIDS. 2007; 21(7):867-9. DOI: 10.1097/QAD.0b013e3280b01822. View

Bunders M, Thorne C, Newell M . Maternal and infant factors and lymphocyte, CD4 and CD8 cell counts in uninfected children of HIV-1-infected mothers. AIDS. 2005; 19(10):1071-9. DOI: 10.1097/01.aids.0000174454.63250.22. View

Mussi-Pinhata M, Rego M, Freimanis L, Kakehasi F, Machado D, Cardoso E . Maternal antiretrovirals and hepatic enzyme, hematologic abnormalities among human immunodeficiency virus type 1-uninfected infants: the NISDI perinatal study. Pediatr Infect Dis J. 2007; 26(11):1032-7. DOI: 10.1097/INF.0b013e31812f56ed. View

Patel K, Shapiro D, Brogly S, Livingston E, Stek A, Bardeguez A . Prenatal protease inhibitor use and risk of preterm birth among HIV-infected women initiating antiretroviral drugs during pregnancy. J Infect Dis. 2010; 201(7):1035-44. PMC: 2946359. DOI: 10.1086/651232. View

Lipshultz S, Easley K, Orav E, Kaplan S, Starc T, Bricker J . Absence of cardiac toxicity of zidovudine in infants. Pediatric Pulmonary and Cardiac Complications of Vertically Transmitted HIV Infection Study Group. N Engl J Med. 2000; 343(11):759-66. DOI: 10.1056/NEJM200009143431102. View

Culnane M, Fowler M, Lee S, McSherry G, Brady M, ODonnell K . Lack of long-term effects of in utero exposure to zidovudine among uninfected children born to HIV-infected women. Pediatric AIDS Clinical Trials Group Protocol 219/076 Teams. JAMA. 1999; 281(2):151-7. DOI: 10.1001/jama.281.2.151. View

Hughes W, LaFon S, Scott J, Masur H . Adverse events associated with trimethoprim-sulfamethoxazole and atovaquone during the treatment of AIDS-related Pneumocystis carinii pneumonia. J Infect Dis. 1995; 171(5):1295-301. DOI: 10.1093/infdis/171.5.1295. View

10.

Tuomala R, Shapiro D, Mofenson L, Bryson Y, Culnane M, Hughes M . Antiretroviral therapy during pregnancy and the risk of an adverse outcome. N Engl J Med. 2002; 346(24):1863-70. DOI: 10.1056/NEJMoa991159. View

11.

Chenadec J, Mayaux M, Guihenneuc-Jouyaux C, Blanche S . Perinatal antiretroviral treatment and hematopoiesis in HIV-uninfected infants. AIDS. 2003; 17(14):2053-61. DOI: 10.1097/00002030-200309260-00006. View

12.

Schulte J, Dominguez K, Sukalac T, Bohannon B, Fowler M . Declines in low birth weight and preterm birth among infants who were born to HIV-infected women during an era of increased use of maternal antiretroviral drugs: Pediatric Spectrum of HIV Disease, 1989-2004. Pediatrics. 2007; 119(4):e900-6. DOI: 10.1542/peds.2006-1123. View

13.

Sperling R, Shapiro D, McSherry G, Britto P, Cunningham B, Culnane M . Safety of the maternal-infant zidovudine regimen utilized in the Pediatric AIDS Clinical Trial Group 076 Study. AIDS. 1998; 12(14):1805-13. DOI: 10.1097/00002030-199814000-00012. View

14.

Brogly S, Williams P, Seage 3rd G, Van Dyke R . In utero nucleoside reverse transcriptase inhibitor exposure and cancer in HIV-uninfected children: an update from the pediatric AIDS clinical trials group 219 and 219C cohorts. J Acquir Immune Defic Syndr. 2006; 41(4):535-6. DOI: 10.1097/01.qai.0000194735.66322.d9. View

15.

Tuomala R, Watts D, Li D, Vajaranant M, Pitt J, Hammill H . Improved obstetric outcomes and few maternal toxicities are associated with antiretroviral therapy, including highly active antiretroviral therapy during pregnancy. J Acquir Immune Defic Syndr. 2005; 38(4):449-73. DOI: 10.1097/01.qai.0000139398.38236.4d. View

16.

. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992; 41(RR-17):1-19. View

17.

Townsend C, Willey B, Cortina-Borja M, Peckham C, Tookey P . Antiretroviral therapy and congenital abnormalities in infants born to HIV-infected women in the UK and Ireland, 1990-2007. AIDS. 2009; 23(4):519-24. DOI: 10.1097/QAD.0b013e328326ca8e. View

18.

Machado E, Hofer C, Costa T, Nogueira S, Oliveira R, Abreu T . Pregnancy outcome in women infected with HIV-1 receiving combination antiretroviral therapy before versus after conception. Sex Transm Infect. 2008; 85(2):82-7. PMC: 2864649. DOI: 10.1136/sti.2008.032300. View

19.

Patel D, Thorne C, Fiore S, Newell M . Does highly active antiretroviral therapy increase the risk of congenital abnormalities in HIV-infected women?. J Acquir Immune Defic Syndr. 2005; 40(1):116-8. DOI: 10.1097/01.qai.0000156854.99769.a5. View

20.

Alimenti A, Forbes J, Oberlander T, Money D, Grunau R, Papsdorf M . A prospective controlled study of neurodevelopment in HIV-uninfected children exposed to combination antiretroviral drugs in pregnancy. Pediatrics. 2006; 118(4):e1139-45. DOI: 10.1542/peds.2006-0525. View