OC9 Impact of combined antiretroviral prophylaxis on health outcomes in HIV-exposed neonates

Abstract

Modern approaches to administration of antiretroviral therapy (ART) to prevent HIV transmission from an infected woman to her child during pregnancy, labor, and delivery (in case she does not breastfeed her child) significantly reduce the risk of newborn infection. Combined ART is indicated for children with perinatal HIV exposure at high risk of being infected and includes administration of three oral antiretrovirals: zidovudine, nevirapine, lamivudine. The aim To assess the health of newborns, who underwent the combined antiretroviral therapy to prevent perinatal HIV transmission. Materials and methods We conducted a post-hoc analysis of 163 cases of HIV-positive women and their newborns at Irkutsk Perinatal Centre (tertiary medical centre), covering 2017–2018 years. Inclusion criteria were high risk of perinatal HIV transmission (a woman did not take antepartum ART, unknown HIV viral load or viral load near delivery is more than 50 copies/ml), a positive result of rapid (point-of-care) HIV antibody test in the mother during delivery, and epidemiological parameters. All newborns with perinatal HIV exposure were given three drug regimen, were formula-fed, and their blood was tested by means of polymerase chain reaction. The follow-up of newborns included clinical monitoring, assessment of hematologic (anemia, neutropenia) and other adverse effects of ART. Results Out of 445 newborns with perinatal HIV exposure, 163 (36.6%) neonates underwent combined ART. The most frequent causes of combination ART prescription were: no adherence (34.8%) to or no taking (39%) ART by the mother of the neonate during pregnancy, high HIV viral load (17.2%), and epidemiological indications (parenteral substances use during pregnancy – 9%). Fifty-six (34.3%) cases resulted in premature births. An average HIV viral load near delivery was 2800 [150; 8100] copies/ml. Average body weight of newborns was 2590 [700; 4180] grams. Among adverse clinical effects of ART in 60% of prematurely-born HIV-exposed neonates, symptoms of enteropathy prevailed; 19.7% of newborns developed severe anemia by the 28th day after birth. HIV RNA was detected in 1 (0.6%) newborn of this group. Four (2.4%) newborns with perinatal HIV exposure died. Conclusions Lack of social and medical support of reproductive women, belonging to risk groups, increases the risk of perinatal HIV transmission. Personalized approach to ART planning helps not only to reduce the risk of mother-to-child transmission, but also avoid toxic side-effects of preparations on neonates with perinatal HIV exposure.