In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana
Identifieur interne : 001D64 ( Pmc/Corpus ); précédent : 001D63; suivant : 001D65In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana
Auteurs : Kathleen M. Powis ; Laura Smeaton ; Michael D. Hughes ; Esther A. Tumbare ; Sajini Souda ; Jennifer Jao ; Katlheen E. Wirth ; Joseph Makhema ; Shahin Lockman ; Wafaie Fawzi ; Max Essex ; Roger ShapiroSource :
- AIDS (London, England) [ 0269-9370 ] ; 2016.
Abstract
To assess associations between in-utero triple antiretrovirals (cART) versus zidovudine (ZDV) monotherapy exposure and growth among HIV-uninfected children of HIV-infected women in Botswana.
Secondary retrospective data analysis from two randomized intervention trials of mother-to-child HIV transmission prevention.
The Mashi and Mma Bana studies enrolled HIV-infected pregnant women, following their children through 24 months of age. This analysis includes singleton, full-term, HIV-exposed uninfected children. Mothers received cART or ZDV at least 2 weeks predelivery, and breastfed up to 6 months. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z-scores were derived. Mean z-scores were compared by exposure group at 24 months (
Of 819 children, 303 were ZDV- and 516 cART-exposed
At 24 months, in-utero cART-exposed children had significantly lower LAZ and WAZ. Poor growth impacts childhood and adult mortality. These findings raise concerns for potential lasting health impacts among HIV-exposed uninfected children with in-utero cART exposure.
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DOI: 10.1097/QAD.0000000000000895
PubMed: 26684818
PubMed Central: 4685731
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana</title><author><name sortKey="Powis, Kathleen M" sort="Powis, Kathleen M" uniqKey="Powis K" first="Kathleen M." last="Powis">Kathleen M. Powis</name><affiliation><nlm:aff id="A1">Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation></author><author><name sortKey="Smeaton, Laura" sort="Smeaton, Laura" uniqKey="Smeaton L" first="Laura" last="Smeaton">Laura Smeaton</name><affiliation><nlm:aff id="A4">Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Hughes, Michael D" sort="Hughes, Michael D" uniqKey="Hughes M" first="Michael D." last="Hughes">Michael D. Hughes</name><affiliation><nlm:aff id="A4">Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Tumbare, Esther A" sort="Tumbare, Esther A" uniqKey="Tumbare E" first="Esther A." last="Tumbare">Esther A. Tumbare</name><affiliation><nlm:aff id="A5">Elizabeth Glaser Pediatric AIDS Foundation, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Souda, Sajini" sort="Souda, Sajini" uniqKey="Souda S" first="Sajini" last="Souda">Sajini Souda</name><affiliation><nlm:aff id="A6">Faculty of Medicine, University of Botswana, New York City, New York, USA</nlm:aff></affiliation></author><author><name sortKey="Jao, Jennifer" sort="Jao, Jennifer" uniqKey="Jao J" first="Jennifer" last="Jao">Jennifer Jao</name><affiliation><nlm:aff id="A7">Divisions of Infectious Diseases and General Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York City, New York, USA</nlm:aff></affiliation></author><author><name sortKey="Wirth, Katlheen E" sort="Wirth, Katlheen E" uniqKey="Wirth K" first="Katlheen E." last="Wirth">Katlheen E. Wirth</name><affiliation><nlm:aff id="A8">Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Makhema, Joseph" sort="Makhema, Joseph" uniqKey="Makhema J" first="Joseph" last="Makhema">Joseph Makhema</name><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation></author><author><name sortKey="Lockman, Shahin" sort="Lockman, Shahin" uniqKey="Lockman S" first="Shahin" last="Lockman">Shahin Lockman</name><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation><affiliation><nlm:aff id="A9">Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Fawzi, Wafaie" sort="Fawzi, Wafaie" uniqKey="Fawzi W" first="Wafaie" last="Fawzi">Wafaie Fawzi</name><affiliation><nlm:aff id="A10">Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Essex, Max" sort="Essex, Max" uniqKey="Essex M" first="Max" last="Essex">Max Essex</name><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation></author><author><name sortKey="Shapiro, Roger" sort="Shapiro, Roger" uniqKey="Shapiro R" first="Roger" last="Shapiro">Roger Shapiro</name><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation><affiliation><nlm:aff id="A11">Beth Israel Deaconess Medical Center, Infectious Diseases Department, Boston, Massachusetts, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26684818</idno><idno type="pmc">4685731</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685731</idno><idno type="RBID">PMC:4685731</idno><idno type="doi">10.1097/QAD.0000000000000895</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">001D64</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001D64</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana</title><author><name sortKey="Powis, Kathleen M" sort="Powis, Kathleen M" uniqKey="Powis K" first="Kathleen M." last="Powis">Kathleen M. Powis</name><affiliation><nlm:aff id="A1">Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation></author><author><name sortKey="Smeaton, Laura" sort="Smeaton, Laura" uniqKey="Smeaton L" first="Laura" last="Smeaton">Laura Smeaton</name><affiliation><nlm:aff id="A4">Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Hughes, Michael D" sort="Hughes, Michael D" uniqKey="Hughes M" first="Michael D." last="Hughes">Michael D. Hughes</name><affiliation><nlm:aff id="A4">Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Tumbare, Esther A" sort="Tumbare, Esther A" uniqKey="Tumbare E" first="Esther A." last="Tumbare">Esther A. Tumbare</name><affiliation><nlm:aff id="A5">Elizabeth Glaser Pediatric AIDS Foundation, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Souda, Sajini" sort="Souda, Sajini" uniqKey="Souda S" first="Sajini" last="Souda">Sajini Souda</name><affiliation><nlm:aff id="A6">Faculty of Medicine, University of Botswana, New York City, New York, USA</nlm:aff></affiliation></author><author><name sortKey="Jao, Jennifer" sort="Jao, Jennifer" uniqKey="Jao J" first="Jennifer" last="Jao">Jennifer Jao</name><affiliation><nlm:aff id="A7">Divisions of Infectious Diseases and General Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York City, New York, USA</nlm:aff></affiliation></author><author><name sortKey="Wirth, Katlheen E" sort="Wirth, Katlheen E" uniqKey="Wirth K" first="Katlheen E." last="Wirth">Katlheen E. Wirth</name><affiliation><nlm:aff id="A8">Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Makhema, Joseph" sort="Makhema, Joseph" uniqKey="Makhema J" first="Joseph" last="Makhema">Joseph Makhema</name><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation></author><author><name sortKey="Lockman, Shahin" sort="Lockman, Shahin" uniqKey="Lockman S" first="Shahin" last="Lockman">Shahin Lockman</name><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation><affiliation><nlm:aff id="A9">Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Fawzi, Wafaie" sort="Fawzi, Wafaie" uniqKey="Fawzi W" first="Wafaie" last="Fawzi">Wafaie Fawzi</name><affiliation><nlm:aff id="A10">Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation></author><author><name sortKey="Essex, Max" sort="Essex, Max" uniqKey="Essex M" first="Max" last="Essex">Max Essex</name><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation></author><author><name sortKey="Shapiro, Roger" sort="Shapiro, Roger" uniqKey="Shapiro R" first="Roger" last="Shapiro">Roger Shapiro</name><affiliation><nlm:aff id="A2">Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</nlm:aff></affiliation><affiliation><nlm:aff id="A11">Beth Israel Deaconess Medical Center, Infectious Diseases Department, Boston, Massachusetts, USA</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To assess associations between in-utero triple antiretrovirals (cART) versus zidovudine (ZDV) monotherapy exposure and growth among HIV-uninfected children of HIV-infected women in Botswana.</p></sec><sec id="S2"><title>Design</title><p id="P2">Secondary retrospective data analysis from two randomized intervention trials of mother-to-child HIV transmission prevention.</p></sec><sec id="S3"><title>Methods</title><p id="P3">The Mashi and Mma Bana studies enrolled HIV-infected pregnant women, following their children through 24 months of age. This analysis includes singleton, full-term, HIV-exposed uninfected children. Mothers received cART or ZDV at least 2 weeks predelivery, and breastfed up to 6 months. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z-scores were derived. Mean z-scores were compared by exposure group at 24 months (<italic>t</italic>-test, linear regression).</p></sec><sec id="S4"><title>Results</title><p id="P4">Of 819 children, 303 were ZDV- and 516 cART-exposed <italic>in utero</italic>. Maternal median enrolment CD4<sup>+</sup> was higher among ZDV versus cART-treated mothers (393 versus 324 cells/µl; <italic>P</italic> < 0.0001). Median duration of antepartum antiretroviral use was shorter among ZDV-treated women (5.7 versus 12.0 weeks; <italic>P</italic> < 0.0001). Median months breastfed were similar (5.9 and 6.0; <italic>P</italic> = 0.43). At 24 months, mean LAZ and WAZ were significantly lower among cART-exposed children (LAZ −1.01 versus −0.74; <italic>P</italic> = 0.003) (WAZ −0.53 versus −0.30; <italic>P</italic> = 0.002) in unadjusted analyses. Adjusting for maternal CD4<sup>+</sup>, viral load, enrolment site and maternal anthropometric measures, cART-exposed children had significantly lower LAZ and WAZ at 24 months (<italic>P</italic> = 0.0004 for both).</p></sec><sec id="S5"><title>Conclusion</title><p id="P5">At 24 months, in-utero cART-exposed children had significantly lower LAZ and WAZ. Poor growth impacts childhood and adult mortality. These findings raise concerns for potential lasting health impacts among HIV-exposed uninfected children with in-utero cART exposure.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id><journal-id journal-id-type="pubmed-jr-id">1493</journal-id><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-id journal-id-type="iso-abbrev">AIDS</journal-id><journal-title-group><journal-title>AIDS (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26684818</article-id><article-id pub-id-type="pmc">4685731</article-id><article-id pub-id-type="doi">10.1097/QAD.0000000000000895</article-id><article-id pub-id-type="manuscript">NIHMS728580</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Powis</surname><given-names>Kathleen M.</given-names></name><xref ref-type="aff" rid="A1">a</xref><xref ref-type="aff" rid="A2">b</xref><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Smeaton</surname><given-names>Laura</given-names></name><xref ref-type="aff" rid="A4">d</xref></contrib><contrib contrib-type="author"><name><surname>Hughes</surname><given-names>Michael D.</given-names></name><xref ref-type="aff" rid="A4">d</xref></contrib><contrib contrib-type="author"><name><surname>Tumbare</surname><given-names>Esther A.</given-names></name><xref ref-type="aff" rid="A5">e</xref></contrib><contrib contrib-type="author"><name><surname>Souda</surname><given-names>Sajini</given-names></name><xref ref-type="aff" rid="A6">f</xref></contrib><contrib contrib-type="author"><name><surname>Jao</surname><given-names>Jennifer</given-names></name><xref ref-type="aff" rid="A7">g</xref></contrib><contrib contrib-type="author"><name><surname>Wirth</surname><given-names>Katlheen E.</given-names></name><xref ref-type="aff" rid="A8">h</xref></contrib><contrib contrib-type="author"><name><surname>Makhema</surname><given-names>Joseph</given-names></name><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Lockman</surname><given-names>Shahin</given-names></name><xref ref-type="aff" rid="A2">b</xref><xref ref-type="aff" rid="A3">c</xref><xref ref-type="aff" rid="A9">i</xref></contrib><contrib contrib-type="author"><name><surname>Fawzi</surname><given-names>Wafaie</given-names></name><xref ref-type="aff" rid="A10">j</xref></contrib><contrib contrib-type="author"><name><surname>Essex</surname><given-names>Max</given-names></name><xref ref-type="aff" rid="A2">b</xref><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Shapiro</surname><given-names>Roger</given-names></name><xref ref-type="aff" rid="A2">b</xref><xref ref-type="aff" rid="A3">c</xref><xref ref-type="aff" rid="A11">k</xref></contrib></contrib-group><aff id="A1"><label>a</label>Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA</aff><aff id="A2"><label>b</label>Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</aff><aff id="A3"><label>c</label>Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana</aff><aff id="A4"><label>d</label>Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA</aff><aff id="A5"><label>e</label>Elizabeth Glaser Pediatric AIDS Foundation, Zimbabwe</aff><aff id="A6"><label>f</label>Faculty of Medicine, University of Botswana, New York City, New York, USA</aff><aff id="A7"><label>g</label>Divisions of Infectious Diseases and General Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York City, New York, USA</aff><aff id="A8"><label>h</label>Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA</aff><aff id="A9"><label>i</label>Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA</aff><aff id="A10"><label>j</label>Departments of Global Health and Population, Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA</aff><aff id="A11"><label>k</label>Beth Israel Deaconess Medical Center, Infectious Diseases Department, Boston, Massachusetts, USA</aff><author-notes><corresp id="cor1">Correspondence to Kathleen M Powis, 125 Nashua St, Office 8426, Boston, MA 02114, USA. Tel: +617 643 2054; fax: +617 643 9105; <email>kpowis@mgh.harvard.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>7</day><month>10</month><year>2015</year></pub-date><pub-date pub-type="ppub"><month>1</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>1</month><year>2017</year></pub-date><volume>30</volume><issue>2</issue><fpage>211</fpage><lpage>220</lpage><pmc-comment>elocation-id from pubmed: 10.1097/QAD.0000000000000895</pmc-comment>
<abstract><sec id="S1"><title>Objective</title><p id="P1">To assess associations between in-utero triple antiretrovirals (cART) versus zidovudine (ZDV) monotherapy exposure and growth among HIV-uninfected children of HIV-infected women in Botswana.</p></sec><sec id="S2"><title>Design</title><p id="P2">Secondary retrospective data analysis from two randomized intervention trials of mother-to-child HIV transmission prevention.</p></sec><sec id="S3"><title>Methods</title><p id="P3">The Mashi and Mma Bana studies enrolled HIV-infected pregnant women, following their children through 24 months of age. This analysis includes singleton, full-term, HIV-exposed uninfected children. Mothers received cART or ZDV at least 2 weeks predelivery, and breastfed up to 6 months. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z-scores were derived. Mean z-scores were compared by exposure group at 24 months (<italic>t</italic>-test, linear regression).</p></sec><sec id="S4"><title>Results</title><p id="P4">Of 819 children, 303 were ZDV- and 516 cART-exposed <italic>in utero</italic>. Maternal median enrolment CD4<sup>+</sup> was higher among ZDV versus cART-treated mothers (393 versus 324 cells/µl; <italic>P</italic> < 0.0001). Median duration of antepartum antiretroviral use was shorter among ZDV-treated women (5.7 versus 12.0 weeks; <italic>P</italic> < 0.0001). Median months breastfed were similar (5.9 and 6.0; <italic>P</italic> = 0.43). At 24 months, mean LAZ and WAZ were significantly lower among cART-exposed children (LAZ −1.01 versus −0.74; <italic>P</italic> = 0.003) (WAZ −0.53 versus −0.30; <italic>P</italic> = 0.002) in unadjusted analyses. Adjusting for maternal CD4<sup>+</sup>, viral load, enrolment site and maternal anthropometric measures, cART-exposed children had significantly lower LAZ and WAZ at 24 months (<italic>P</italic> = 0.0004 for both).</p></sec><sec id="S5"><title>Conclusion</title><p id="P5">At 24 months, in-utero cART-exposed children had significantly lower LAZ and WAZ. Poor growth impacts childhood and adult mortality. These findings raise concerns for potential lasting health impacts among HIV-exposed uninfected children with in-utero cART exposure.</p></sec></abstract><kwd-group><kwd>growth</kwd><kwd>HIV-exposed uninfected infants</kwd><kwd>in-utero triple antiretrovirals</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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