Infant Outcomes After Maternal Antiretroviral Exposure in Resource-Limited Settings

Pediatrics. 2012 Jun;129(6):e1525-32. doi: 10.1542/peds.2011-2340. Epub 2012 May 14.

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.

Trial registration: ClinicalTrials.gov NCT00084136.

Publication types

  • Clinical Trial, Phase IV
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-HIV Agents / therapeutic use*
  • Cohort Studies
  • Developing Countries / economics
  • Female
  • Follow-Up Studies
  • HIV Infections / drug therapy
  • HIV Infections / economics
  • HIV Infections / epidemiology*
  • HIV-1*
  • Health Resources* / economics
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical* / economics
  • Infectious Disease Transmission, Vertical* / prevention & control
  • Internationality
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy
  • Pregnancy Complications, Infectious / economics
  • Pregnancy Complications, Infectious / epidemiology*
  • Prospective Studies
  • Treatment Outcome
  • Viral Load

Substances

  • Anti-HIV Agents

Associated data

  • ClinicalTrials.gov/NCT00084136

Grant support