Abstract
BackgroundEffects of antiretroviral therapy (ART) on birth outcomes remain controversial.ObjectiveTo assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW).MethodsA cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (<37 weeks) and LBW (<2,500g) were analyzed using univariate and multivariate logistic regression; with p<0.05 considered statistically significant.ResultsOf the 760 infants, 481 were born from cART-exposed mothers against 279 from maternal-ZDV. Median maternal CD4 count was 378 [interquartile range (IQR): 253–535] cells/mm3. Median duration of ART at onset of delivery was 13 [IQR: 10–17] weeks. In the cART-group, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens. Events of PTB were not significantly higher in the cART-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of LBW were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05). Other factors (parity, maternal age at delivery or CD4 cell count) were not associated with PTB.ConclusioncART, initiated during pregnancy, would be an independent factor of LBW. In the era of option B+ (lifelong ART to all HIV-pregnant women), further studies would guide towards measures limiting onsets of LBW.
Highlights
During the last decade, efforts in preventing mother-to-child transmission (PMTCT) of HIV have significantly reduced new HIV pediatric infections worldwide
In the cARTgroup, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens
Events of preterm birth (PTB) were not significantly higher in the combination antiretroviral therapy (cART)-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of low birth weight (LBW) were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05)
Summary
Efforts in preventing mother-to-child transmission (PMTCT) of HIV have significantly reduced new HIV pediatric infections worldwide. Understanding the impact of commonly used antiretrovirals on birth outcomes in SSA would serve in designing interventions aiming at: (a) continuing current ART during pregnancy without further interventions, (b) continuing current ART during with specific monitoring measures, or (c) switching from current ART to potential regimens with safer birth outcomes. Such considerations are of utmost importance in SSA countries whereby HIV-infection during pregnancy is consistent, in the frame of PMTCT uptake [3].
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