1218. Infant Hematologic and Hepatic Toxicity Associated with Exposure to Different Maternal HAART
Session: Poster Abstract Session: Pediatric HIV
Saturday, October 22, 2011
Room: Poster Hall B1
Background: : Maternal highly active antiretroviral treatment (HAART) is used for prevention of mother-to-child-transmission, but there are few data comparing infant laboratory adverse events (AE) with different HAART. Our objective was to compare rates of AE in infants exposed to different maternal antiretrovirals (ARV).

Methods: Retrospective chart review of 163 uninfected infants born to 158 HAART-treated women between 1997 and 2009. Infants received 6 wks of zidovudine (ZDV); some infants received additional ARV for increased MTCT risk. Infant hemoglobin (Hgb), absolute neutrophil count (ANC), platelets (plts), hepatic transaminases (AST, ALT) and total bilirubin (tB), evaluated at age 0 and 4 wks, were graded per the DAIDS 2004 Table of Adverse Events. Logistic regression was used to model grade > 1 AE (yes/no) as a function of maternal ARV (drug received >28 days just prior to delivery) and any confounding variable (pre-term, c-section, illicit drug use, race, ethnicity, and infant ARV) that changed the odds ratio (OR, 95% confidence interval) by > 20%.

Results: Overall rates of infant AE (grade >1) at 0 wk for Hgb, ANC, plts, AST, ALT, and tB were 9%, 27%, 4%, 16%, 1%, 0%, respectively.  However serious AE (grade > 3) exceeded 1% only for ANC (13%). Maternal nelfinavir (NFV) (n=39) compared to lopinavir/ritonavir (LPVr) (n=59) was associated with a higher rate of Hgb AE (OR 7.4 (1.4-39.0), p=0.02) and any AE (all 6 tests) (OR 5.3 (1.9-14.9), p=0.002). The relationship was maintained when limited to infants with the same maternal NRTI (ZDV and lamivudine).  For infants exposed to maternal atazanavir (n=16) rates of grade >1 AE were Hgb(6%), ANC(28%), AST(6%), ALT(0%), tB(0%); small sample size precluded statistical comparisons.  Infants exposed to maternal ZDV (n=85) versus those exposed to either stavudine (n=17) or tenofovir (n=14) tended to have more Hgb AE (OR 4.0 (0.49-32.6), p=0.20) and fewer ANC AE (OR 0.42 (0.10-1.7), p=0.21), although these did not reach statistical significance.

Conclusion: Infant hematologic and hepatic AE were frequent, but there were few serious AE. Maternal LPVr may be associated with a lower rate of AE compared to NFV. Additional investigation of the effect of specific maternal ARV on infant outcomes is needed.  


Subject Category: P. Pediatric and perinatal infections

Christiana Smith, MD1, Elizabeth McFarland, MD1, Jeri Forster-Harwood, PhD1, Adriana Weinberg, MD1, Myron Levin, MD1, Jill Davies, MD1, Jennifer Pappas, LCSW, MPH 2, Kay Kinzie, BSN, MSN, FNP-C1, Emily Barr, CPNP, CNM, MSN, RN 1, Suzanne Paul, RN, FNP-BC1, Carol Salbenblatt, RN, MSN2 and Anna Vazquez, BS1, (1)University of Colorado Anschutz Medical Campus, Aurora, CO, (2)The Children's Hospital, Aurora, CO

Disclosures:

C. Smith, None

E. McFarland, None

J. Forster-Harwood, None

A. Weinberg, None

M. Levin, None

J. Davies, None

J. Pappas, None

K. Kinzie, None

E. Barr, None

S. Paul, None

C. Salbenblatt, None

A. Vazquez, None

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