Maternal antiretrovirals and hepatic enzyme, Hematologic abnormalities among human immunodeficiency virus type 1-uninfected infants - the NISDI perinatal study

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Mussi-Pinhata, Marisa M.
Aparecida, Maria
Rego, Maria Aparecida C.
Freimanis, Laura
Kakehasi, Fabiana M.
Machado, Daisy Maria
Cardoso, Edmundo M.
Read, Jennifer S.
NISDI Perinatal Protocol Study Grp
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Objectives: To assess hepatic enzyme (HE) and hematologic abnormalities among human immunodeficiency virus-1-uninfected infants according to maternal antiretroviral regimen during pregnancy.Study Design: in a prospective cohort, HE and hematologic values of human immunodeficiency virus-1-uninfected, term infants with hospital discharge (HD) within 6 days after birth were evaluated. Maternal antiretroviral regimens were categorized as: 1 or 2 nucleoside reverse transcription inhibitors (NRTIs), highly active antiretroviral therapy (HAART)/protease inhibitor (PI), or HAART/non-NRTI.Results: Among 503 infants, 63% and 24% had HE and hemoglobin abnormalities, respectively, at HD. Most or all HE and hemoglobin abnormalities (96-100%) were grade 1 or 2. At HD, infants with maternal HAART/PI or HAART/non-NRTI were more likely to have elevated HE [adjusted odds ratio (AOR): 1.9, 2.4, respectively] compared with infants whose mothers received 1 or 2 NRTIs. Infants with maternal HAART/PI were less likely to have abnormal hemoglobin values at HD (AOR, 0.5) when compared with those whose mothers received 1 or 2 NRTIs. Persistently abnormal hemoglobin and HE values decreased with time, such that <10% of infants had abnormalities at 6 months of age.Conclusions: Maternal receipt of HAART regimens was associated with an increased risk of HE abnormalities, and maternal HAART/PI was associated with a lower risk of abnormal hemoglobin values, at HD. Abnormalities of HE and hemoglobin were generally mild and transient.
Pediatric Infectious Disease Journal. Philadelphia: Lippincott Williams & Wilkins, v. 26, n. 11, p. 1032-1037, 2007.