ART Initiated Pre-Pregnancy Lowers Hospitalization due to Infection in HIV-Exposed Infants

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The lifelong administration of ART to all HIV-infected women, could have a positive impact on the health of infants exposed to HIV but who are seronegative for the virus.
The lifelong administration of ART to all HIV-infected women, could have a positive impact on the health of infants exposed to HIV but who are seronegative for the virus.

Beginning antiretroviral therapy (ART) prior to becoming pregnant was associated with a reduced risk for hospitalization because of infection in infants exposed to HIV but seronegative for the virus, according to a study published in Clinical Infectious Diseases.

The incidence of pediatric HIV infection has been markedly reduced by successful prevention of mother to child transmission, but it has still resulted in an increasing number of infants who have been exposed to the virus. Infants exposed to HIV but who are seronegative for the virus face a higher risk for serious clinical complications compared to those who have not been exposed. This study prospectively evaluated the relative risk for hospitalization because of infection in 132 infants exposed to HIV but were seronegative for the virus vs 123 unexposed infants, all of whom were born in a high-income country.

Within this cohort, 27 of the infants exposed to HIV but seronegative for the virus and 14 unexposed infants were hospitalized because of an infection during their first year of life (adjusted hazard ratio [aHR] 2.33; 95% CI, 1.10-4.97), but higher risk was most associated with time to maternal ART initiation. The risk for hospitalization because of an infection was increased 4-fold in infants exposed to HIV but seronegative for the virus compared with infants who were not exposed (aHR 3.84; 95% CI, 1.69-8.71) when mothers initiated ART during pregnancy, but it was not increased significantly (aHR 1.42; 95% CI, .58-3.48) when ART was initiated prior to becoming pregnant.

“The lifelong administration of ART to all HIV infected women, as recommended by the World Health Organization, could therefore positively impact the health of infants exposed to HIV but [who] are seronegative for the virus,” the researchers noted. They added that confirming these observations in low- and middle-income nations “where the burden of HIV and pediatric infectious diseases [is] highest would have critical implications for the health of infants exposed to HIV but seronegative for the virus worldwide.”

Reference

Goetghebuer T, Smolen KK, Adler C, et al. Initiation of anti-retroviral therapy before pregnancy reduces the risk of infection-related hospitalization in HIV-exposed uninfected infants born in a high-income country [published online September 12, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy673

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