In utero and postnatal exposure to antiretrovirals among hiv-exposed but uninfected children in the United States
journal contributionposted on 2012-03-21, 00:00 authored by Raymond Griner, Paige L. Williams, Jennifer S. Read, George R. Seage, Marilyn Crain, Ram Yogev, Rohan Hazra, Kenneth Rich
OBJECTIVE Antiretroviral (ARV) drugs are routinely provided to HIV-infected pregnant women to prevent HIV mother-to-child transmission. Although ARV use has significantly reduced mother-to-child transmission to <2% in the United States, it remains crucial to monitor uninfected infants and children for adverse consequences of in utero ARV exposure. METHODS We studied neurodevelopmental function in HIV-exposed uninfected children who were enrolled in Pediatric AIDS Clinical Trials Group 219/219C, a multisite, prospective, cohort study. Mental and motor functioning were assessed with the Bayley Scales of Infant Development (BSID), first and second editions. ARV exposure information was collected during pregnancy or within the first years of life. Linear regression methods were used to evaluate the association of in utero ARV exposure on Mental Developmental Index and Psychomotor Developmental Index at 2 years of age, controlling for demographic factors (age, gender, and race/ethnicity) and potential confounders: test version, primary language, primary caregiver, caregiver education level, low birth weight, geographic and urban/rural location, birth year, and maternal illicit drug use. RESULTS Among 1840 infants who were born between 1993 and 2006, 1694 (92%) were exposed to ARV in utero and 146 (8%) were not exposed. After controlling for confounders, children who were exposed in utero to any ARV did not have lower Mental Developmental Index and Psychomotor Developmental Index scores than unexposed children. Among low birth weight infants, significantly higher BSID scores were observed for prenatally ARV-exposed than unexposed children. Maternal illicit drug use was reported for 17% of mothers but was not associated with BSID scores. CONCLUSIONS Mental and motor functioning scores were not lower for infants with in utero ARV exposure compared with no exposure. Although these results are reassuring, continued evaluation of uninfected children with in utero ARV exposure for long-term adverse outcomes is important.
Overall support for the International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) was provided by the National Institute of Allergy and Infectious Diseases (U01 AI068632) and the NICHD International and Domestic Pediatric and Maternal HIV Clinical Trials Network supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts N01-3-3345 and HHSN267200800001C). Support for the Statistical and Data Analysis Center at Harvard School of Public Health was provided under the National Institute of Allergy and Infectious Diseases cooperative agreement 5 U01 AI41110 with the PACTG) and 1 U01 AI068616 with IMPAACT.
Publisher StatementThis is a copy of an article published in the AIDS Patient Care and STDs © 2010 copyright Mary Ann Liebert, Inc.; AIDS Patient Care and STDs is available online at: http://www.liebertonline.com. DOI: 10.1542/peds.2009-1112
PublisherMary Ann Liebert