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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Increased risk of severe infant anemia after exposure to maternal HAART, Botswana
Journal of Acquired Immune Deficiency Syndromes, Volume 56, No. 5, Year 2011
Notification
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Description
Background: Maternal highly-active antiretroviral therapy (HAART) reduces mother-to-child HIV transmission but may increase the risk for infant anemia. Methods: The incidence of first severe anemia (grade 3 or 4, Division of AIDS 2004 Toxicity Table) was assessed among HIV-uninfected infants in the Mashi and Mma Bana mother-to-child HIV transmission prevention trials in Botswana. Severe anemia rates were compared between 3 groups: infants exposed to maternal HAART in utero and during breastfeeding (BF) and 1 month of postnatal zidovudine (ZDV) (HAART-BF); infants exposed to maternal ZDV in utero, 6 months of postnatal ZDV, and BF (ZDV-BF); and infants exposed to maternal ZDV in utero, 1 month of postnatal ZDV, and formula-feeding (ZDV-FF). Results: A total of 1719 infants were analyzed-691 HAART-BF, 503 ZDV-BF, and 525 ZDV-FF. Severe anemia was detected in 118 infants (7.4%). By 6 months, 12.5% of HAART-BF infants experienced severe anemia, compared with 5.3% of ZDV-BF (P < 0.001) and 2.5% of ZDV-FF infants (P < 0.001). In adjusted analysis, HAART-BF infants were at greater risk of severe anemia than ZDV-BF or ZDV-FF infants (adjusted odds ratios 2.6 and 5.8, respectively; P < 0.001). Most anemias were asymptomatic and improved with iron/multivitamin supplementation and cessation of ZDV exposure. However, 11 infants (0.6% of all infants) required transfusion for symptomatic anemia. Microcytosis and hypochromia were common among infants with severe anemia. Conclusions: Exposure to maternal HAART starting in utero was associated with severe infant anemia. Confirmation of this finding and possible strategies to mitigate hematologic toxicity warrant further study. © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Dryden-Peterson, Scott L.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Shapiro, Roger L.
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Israel, Beth
Beth Israel Deaconess Medical Center
Hughes, Michael D.
United States, Boston
Harvard T.h. Chan School of Public Health
Powis, Kathleen M.
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
United States, Boston
Massachusetts General Hospital
Ogwu, Anthony C.
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Moffat, Claire
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Moyo, Sikhulile M.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Makhema, Joseph M.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Essex, Max E.
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Lockman, Shahin
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard T.h. Chan School of Public Health
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Statistics
Citations: 49
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1097/QAI.0b013e31820bd2b6
ISSN:
15254135
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Botswana