1. Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants.
- Author
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Anugulruengkitt S, Suntarattiwong P, Ounchanum P, Srirompotong U, Jantarabenjakul W, Sophonphan J, Punnahitanon S, Pancharoen C, Cressey TR, Chokephaibulkit K, and Puthanakit T
- Subjects
- Drug Therapy, Combination adverse effects, Drug Therapy, Combination methods, Female, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical prevention & control, Lamivudine administration & dosage, Lamivudine adverse effects, Male, Nevirapine administration & dosage, Nevirapine adverse effects, Prospective Studies, Thailand, Treatment Outcome, Zidovudine administration & dosage, Zidovudine adverse effects, Anti-Retroviral Agents administration & dosage, Anti-Retroviral Agents adverse effects, Chemoprevention adverse effects, Chemoprevention methods, Drug-Related Side Effects and Adverse Reactions epidemiology, HIV Infections prevention & control, Post-Exposure Prophylaxis methods
- 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.
- Published
- 2019
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