Increased risk of severe infant anemia after exposure to maternal HAART, Botswana.

Abstract

BACKGROUND:

Maternal highly-active antiretroviral therapy (HAART) reduces mother-to-child HIV transmission but may increase the risk for infant anemia.

METHODS:

The incidence of first severe anemia (grade 3 or 4, Division of AIDS 2004 Toxicity Table) was assessed among HIV-uninfected infants in the Mashi and Mma Bana mother-to-child HIV transmission prevention trials in Botswana. Severe anemia rates were compared between 3 groups: infants exposed to maternal HAART in utero and during breastfeeding (BF) and 1 month of postnatal zidovudine (ZDV) (HAART-BF); infants exposed to maternal ZDV in utero, 6 months of postnatal ZDV, and BF (ZDV-BF); and infants exposed to maternal ZDV in utero, 1 month of postnatal ZDV, and formula-feeding (ZDV-FF).

RESULTS:

A total of 1719 infants were analyzed-691 HAART-BF, 503 ZDV-BF, and 525 ZDV-FF. Severe anemia was detected in 118 infants (7.4%). By 6 months, 12.5% of HAART-BF infants experienced severe anemia, compared with 5.3% of ZDV-BF (P < 0.001) and 2.5% of ZDV-FF infants (P < 0.001). In adjusted analysis, HAART-BF infants were at greater risk of severe anemia than ZDV-BF or ZDV-FF infants (adjusted odds ratios 2.6 and 5.8, respectively; P < 0.001). Most anemias were asymptomatic and improved with iron/multivitamin supplementation and cessation of ZDV exposure. However, 11 infants (0.6% of all infants) required transfusion for symptomatic anemia. Microcytosis and hypochromia were common among infants with severe anemia.

CONCLUSIONS:

Exposure to maternal HAART starting in utero was associated with severe infant anemia. Confirmation of this finding and possible strategies to mitigate hematologic toxicity warrant further study.

• Authors: Scott Dryden-Peterson, Roger L Shapiro, Michael D Hughes, Kathleen Powis, Anthony Ogwu, Claire Moffat, Sikhulile Moyo, Joseph Makhema, Max Essex, Shahin Lockman
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 56 Issue 5 Pg. 428-36 (Apr 15 2011) ISSN: 1944-7884 [Electronic] United States
• PMID: 21266910 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Reverse Transcriptase Inhibitors
• Zidovudine

Topics

• Adult
• Anemia (chemically induced, epidemiology, physiopathology)
• Antiretroviral Therapy, Highly Active (adverse effects)
• Botswana (epidemiology)
• Breast Feeding
• Female
• HIV Infections (drug therapy, transmission, virology)
• HIV-1 (drug effects)
• Humans
• Incidence
• Infant, Newborn
• Infectious Disease Transmission, Vertical (prevention & control)
• Male
• Perinatal Care
• Pregnancy
• Pregnancy Complications, Infectious (drug therapy, virology)
• Prenatal Exposure Delayed Effects
• Reverse Transcriptase Inhibitors (adverse effects, therapeutic use)
• Severity of Illness Index
• Treatment Outcome
• Zidovudine (adverse effects, therapeutic use)