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Haematological parameters of HIV-1-uninfected infants born to HIV-1-infected mothers
Madeleine J Bunders1, Vincent Bekker, Henriette J Scherpbier
1Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. m.bunders@ich.ucl.ac.jp
Insights
Combination antiretroviral therapy (ART) prevents mother-to-child HIV transmission but can cause lasting changes in infant blood cell counts. Clinical implications of these haematological alterations require further investigation.
Area of Science:
- Paediatric Infectious Diseases
- Clinical Haematology
- Antiretroviral Therapy Research
Background:
- Combination antiretroviral therapy (ART) is crucial for preventing mother-to-child HIV transmission (MTCT).
- Infants born to HIV-1-infected mothers exposed to ART require monitoring for potential adverse effects.
- Understanding the long-term haematological impact of ART exposure in neonates is essential.
Purpose of the Study:
- To investigate haematological parameters in infants exposed to combination antiretroviral therapy (ART) for HIV prevention.
- To compare haematological profiles of ART-exposed infants with non-ART-exposed infants.
- To assess the safety and potential long-term effects of in utero and neonatal ART exposure.
Main Methods:
- A 2-year single-centre follow-up study involving 109 infants born to HIV-1-positive mothers.
- Exclusion of infants with HIV-1 infection, perinatal death, or incomplete data.
- Comparison of haematological parameters in 92 ART-exposed infants versus 75 matched non-ART-exposed controls.
Main Results:
- Low HIV-1 transmission rate (1.8%) observed, linked to maternal non-compliance.
- Persistent reduction in absolute neutrophil counts (ANC) noted in ART-exposed infants up to 8 months.
- Moderate-to-severe ANC toxicity (grade II+) observed in 16 infants; pregnancy duration correlated with toxicity.
Conclusions:
- Combination ART effectively prevents MTCT, but haematological alterations may persist.
- No significant clinical implications such as increased infections were detected.
- Continued prospective monitoring of haematological parameters in ART/HIV-exposed children is recommended.
Aim:
To investigate haematological parameters in infants born to HIV-1-infected mothers and exposed to combination antiretroviral therapy (ART) used to prevent mother-to-child transmission (MTCT).
Methods:
A 2-y single-centre follow-up study performed in 109 infants born to HIV-1-positive mothers. Exclusion criteria for the infants were HIV-1 infection, perinatal death, or insufficient information. Haematological parameters of the remainder of 92 infants born to HIV-1-infected mothers and exposed to ART in utero and neonatally were compared with 75 matched non-ART-exposed children.
Results:
Transmission rate of HIV-1 was 1.8% and occurred when the mother was not compliant with the treatment. In the HIV-1/ART-exposed children there was a long-lasting reduction in absolute neutrophil counts (ANC) until at least 8 mo of age. According to PACTG toxicity scores, 16 infants were suffering from grade II or more (moderate-to-severe) toxicity of ART on ANC. In a multivariable analysis of maternal and neonatal risk factors, pregnancy duration was correlated with moderate-to-severe toxicity on ANC. There were no clinical implications detected, e.g. increased infections or antibiotic treatment.
Conclusion:
ART is successful in preventing MTCT, but alterations in haematological parameters may persist for a long period. The clinical implications remain uncertain. This suggestion increases the importance to continue prospective follow-up on the haematological parameters in ART/HIV-exposed children.
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