Publication: Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
Issued Date
2019-10-01
Resource Type
ISSN
15320987
Other identifier(s)
2-s2.0-85072791175
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Mahidol University
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SCOPUS
Bibliographic Citation
The Pediatric infectious disease journal. Vol.38, No.10 (2019), 1045-1050
Suggested Citation
Suvaporn Anugulruengkitt, Piyarat Suntarattiwong, Pradthana Ounchanum, Ussanee Srirompotong, Watsamon Jantarabenjakul, Jiratchaya Sophonphan, Sunti Punnahitanon, Chitsanu Pancharoen, Tim R. Cressey, Kulkanya Chokephaibulkit, Thanyawee Puthanakit Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants. The Pediatric infectious disease journal. Vol.38, No.10 (2019), 1045-1050. doi:10.1097/INF.0000000000002426 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/51401
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Title
Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
Other Contributor(s)
Harvard T.H. Chan School of Public Health
Chulalongkorn University
University of Liverpool
The HIV Netherlands Australia Thailand Research Collaboration
Khon Kaen Regional Hospital
Faculty of Medicine, Siriraj Hospital, Mahidol University
Queen Sirikit National Institute of Child Health
Chiang Mai University
Faculty of Medicine
Chiangrai Prachanukroh Hospital
Chulalongkorn University
University of Liverpool
The HIV Netherlands Australia Thailand Research Collaboration
Khon Kaen Regional Hospital
Faculty of Medicine, Siriraj Hospital, Mahidol University
Queen Sirikit National Institute of Child Health
Chiang Mai University
Faculty of Medicine
Chiangrai Prachanukroh Hospital
Abstract
BACKGROUND: Combination antiretroviral drug regimens are increasingly preferred for neonatal postexposure prophylaxis (PEP) among HIV-exposed infants with high-risk of transmission. We evaluated the adverse events associated with the use of zidovudine (ZDV)/lamivudine (3TC)/nevirapine (NVP) for neonatal PEP during the first 6 weeks of life. METHODS: A prospective cohort of non-breast-fed HIV-exposed infants was conducted at 5 clinical sites in Thailand. Study population included 100 high-risk HIV-exposed infants (maternal HIV RNA > 50 copies/mL prior to delivery or received antiretroviral therapy less than 12 weeks) and 100 low-risk HIV-exposed neonates. High-risk infants received ZDV/3TC/NVP for 6 weeks whereas low-risk HIV-exposed neonates received a 4-week regimen of ZDV. Complete blood count, aspartate transaminase and alanine transaminase were assessed at birth, 1, 2 and 4 months of life. RESULTS: From October 2015 to November 2017, 200 infants were enrolled, of which 18.5% had low birth weight < 2500 g. The proportion of infants with anemia grade 2 or higher at 1 and 2 months of life between ZDV/3TC/NVP and ZDV prophylaxis was 48.5% vs 32.3% (P=0.02); nevertheless, severe anemia (grade 3) was not significantly different; 9.2% vs 10.2% (P=0.81), respectively. At 1 month old, infants on ZDV/3TC/NVP prophylaxis had significantly higher grade 2 anemia versus infants on ZDV alone (33.0% vs 13.4%; P=0.001); however, no difference was observed at 2 months old. No differences in neutropenia or hepatotoxicity between infant prophylactic regimens were observed. CONCLUSIONS: Triple antiretroviral neonatal PEP with ZDV/3TC/NVP for 6 weeks in high-risk HIV-exposed infants did not significantly increase the risk of short-term toxicity compared with ZDV-monotherapy prophylaxis.