Long-Term Effects of Short-Term Perinatal Exposure to Antiretroviral Drugs

Abstract

Evaluation of: Benhammou V, Warszawski J, Bellec S et al.: Incidence of cancer in children perinatally exposed to nucleoside reverse transcriptase inhibitors. AIDS 22, 2165–2177 (2008). The prevention of mother-to-child transmission of HIV hinges on administration of perinatal antiretroviral drugs, reducing transmission rates from 40 to less than 2%. The safety of short-term exposure to antiretroviral drugs in HIV-uninfected children is paramount to justify widespread implementation. Besides mitochondrial toxicity, lower birth weight and mild hematotoxicity, no major long-term adverse effects, such as teratogenicity, have been documented. Nucleoside inhibitors can potentially be embedded in the genetic material of fetuses. This genotoxicity may predispose HIV-uninfected children to cancers later in life. However, except for didanosine, no increase was measured in childhood cancer up to 5 years after exposure in a large French prospective cohort study, lending further support to the relative safety of short-term use of pre- and perinatal antiretroviral drugs. Nevertheless, the increased likelihood of rare cancers in the CNS after didanosine exposure warrants longer-term follow-up studies.