Exposure of HIV-exposed uninfected infants to antiretrovirals

Abstract

As various national HIV/AIDS control programmes worldwide continue to adopt WHO's option B+ approach, 1 WHOAntiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach. World Health Organization, Geneva, Switzerland2010: 1-105 Google Scholar , 2 WHOProgamme update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. World Health Organization, Geneva:, SwitzerlandApril, 2012 Google Scholar we will continue to have a growing population of infants who have been exposed not only to in-utero HIV infection, but also to prolonged exposure to ante-partum and post-partum antiretroviral drugs, including around 6 weeks of infant prophylaxis with nevirapine combined with triple antiretroviral exposure through breastfeeding. 3 Schouten E Midiani M Makombe S et al. Prevention of mother-to-child transmission of HIV and the health related Millennium Development Goals: time for a public health approach. Lancet. 2011; 378: 282-284 Summary Full Text Full Text PDF PubMed Scopus (195) Google Scholar Most of these infants remain free from HIV infection, and are currently referred to as HIV-exposed and uninfected. There is growing evidence that mortality is higher for these infants than for those who are HIV-unexposed and uninfected. 4 Newell M Coovadia H Cortina-Borja M et al. Mortality of infected and uninfected infants born to HIV infected mothers in Africa: a pooled analysis. Lancet. 2004; 364: 1236-1243 Summary Full Text Full Text PDF PubMed Scopus (907) Google Scholar , 5 Kuhn L Sinkala M Semrau K et al. Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers. Clin Infect Dis. 2010; 50: 437-444 Crossref PubMed Scopus (80) Google Scholar Additionally, in this age of heightened awareness of the importance of early childhood development, one major concern for parents of HIV-exposed and uninfected infants and health-care workers taking care of the family is whether these children have normal neurological development. Are we saving HIV-exposed infants from HIV infection but leaving them with higher morbidity from exposure to the virus and perhaps also exposure to the antiretroviral drugs than unexposed infants? 6 Hutchins J Potterton J Developmental delay in HIV exposed infants in Harare, Zimbabwe. Vulnerable Child Youth Stud. 2013; 9: 43-55 Crossref Scopus (22) Google Scholar Neurodevelopmental effects of ante-partum and post-partum antiretroviral exposure in HIV-exposed and uninfected children versus HIV-unexposed and uninfected children in Uganda and Malawi: a prospective cohort studyMaternal triple antiretroviral exposure during both the ante-partum and post-partum phases did not result in greater developmental risks for the mothers' HIV-exposed and uninfected children through age 60 months, compared with children who were HIV-unexposed and uninfected. This might be because ante-partum triple antiretroviral protection of the health of mothers with HIV during pregnancy might be neuroprotective for the child, and when continued post partum, could enhance the quality of caregiving for the child through better clinical care for the mother. Full-Text PDF