Pregnancy and Infant Outcomes among HIV-Infected Women Taking Long-Term ART with and without Tenofovir in the DART Trial

Simple item page
dc.contributor.authorGibb, Diana M.
dc.contributor.authorKizito, Hilda
dc.contributor.authorRussell, Elizabeth C.
dc.contributor.authorChidziva, Ennie
dc.contributor.authorZalwango, Eva
dc.contributor.authorNalumenya, Ruth
dc.contributor.authorSpyer, Moira
dc.contributor.authorTumukunde, Dinah
dc.contributor.authorNathoo, Kusum
dc.contributor.authorMunderi, Paula
dc.contributor.authorKyomugisha, Hope
dc.contributor.authorHakim, James
dc.contributor.authorGrosskurth, Heiner
dc.contributor.authorGilks, Charles F.
dc.contributor.authorWalker, Sarah
dc.contributor.authorMusoke, Phillipa
dc.date.accessioned2021-12-10T16:07:33Z
dc.date.available2021-12-10T16:07:33Z
dc.date.issued2012
dc.description.abstractFew data have described long-term outcomes for infants born to HIV-infected African women taking antiretroviral therapy (ART) in pregnancy. This is particularly true for World Health Organization (WHO)–recommended tenofovir-containing first-line regimens, which are increasingly used and known to cause renal and bone toxicities; concerns have been raised about potential toxicity in babies due to in utero tenofovir exposure. Methods and Findings: Pregnancy outcome and maternal/infant ART were collected in Ugandan/Zimbabwean HIV-infected women initiating ART during The Development of AntiRetroviral Therapy in Africa (DART) trial, which compared routine laboratory monitoring (CD4; toxicity) versus clinically driven monitoring. Women were followed 15 January 2003 to 28 September 2009. Infant feeding, clinical status, and biochemistry/haematology results were collected in a separate infant study. Effect of in utero ART exposure on infant growth was analysed using random effects models. 382 pregnancies occurred in 302/1,867 (16%) women (4.4/100 woman-years [95% CI 4.0–4.9]). 226/390 (58%) outcomes were live-births, 27 (7%) stillbirths ($22 wk), and 137 (35%) terminations/miscarriages (,22 wk). Of 226 live-births, seven (3%) infants died ,2 wk from perinatal causes and there were seven (3%) congenital abnormalities, with no effect of in utero tenofovir exposure (p.0.4). Of 219 surviving infants, 182 (83%) enrolled in the follow-up study; median (interquartile range [IQR]) age at last visit was 25 (12–38) months. From mothers’ ART, 62/9/111 infants had no/20%–89%/$90% in utero tenofovir exposure; most were also zidovudine/lamivudine exposed. All 172 infants tested were HIV-negative (ten untested). Only 73/ 182(40%) infants were breast-fed for median 94 (IQR 75–212) days. Overall, 14 infants died at median (IQR) age 9 (3–23) months, giving 5% 12-month mortality; six of 14 were HIV-uninfected; eight untested infants died of respiratory infection (three), sepsis (two), burns (one), measles (one), unknown (one). During follow-up, no bone fractures were reported to have occurred; 12/368 creatinines and seven out of 305 phosphates were grade one (16) or two (three) in 14 children with no effect of in utero tenofovir (p.0.1). There was no evidence that in utero tenofovir affected growth after 2 years (p = 0.38). Attained height- and weight for age were similar to general (HIV-uninfected) Ugandan populations. Study limitations included relatively small size and lack of randomisation to maternal ART regimens. Conclusions: Overall 1-year 5% infant mortality was similar to the 2%–4% post-neonatal mortality observed in this region. No increase in congenital, renal, or growth abnormalities was observed with in utero tenofovir exposure. Although some infants died untested, absence of recorded HIV infection with combination ART in pregnancy is encouraging. Detailed safety of tenofovir for pre-exposure prophylaxis will need confirmation from longer term follow-up of larger numbers of exposed children.en_US
dc.identifier.citationGibb DM, Kizito H, Russell EC, Chidziva E, Zalwango E, et al. (2012) Pregnancy and Infant Outcomes among HIV-Infected Women Taking Long-Term ART with and without Tenofovir in the DART Trial. PLoS Med 9(5): e1001217. doi:10.1371/journal.pmed.1001217en_US
dc.identifier.other10.1371/journal.pmed.1001217
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/260
dc.language.isoenen_US
dc.publisherPLoS Meden_US
dc.subjectPregnancyen_US
dc.subjectHIVen_US
dc.subjectInfected Womenen_US
dc.subjectDART Trialen_US
dc.titlePregnancy and Infant Outcomes among HIV-Infected Women Taking Long-Term ART with and without Tenofovir in the DART Trialen_US
dc.typeArticleen_US
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Pregnancy and Infant Outcomes among HIV-Infected Women Taking Long-Term ART with and without Tenofovir in the DART Trial.pdf
Size:
497.15 KB
Format:
Adobe Portable Document Format
Description:
Article
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Medical and Health Sciences