Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants

© 2019 Pediatric Infectious Disease Journal. All rights reserved. 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...

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Main Authors: Suvaporn Anugulruengkitt, Piyarat Suntarattiwong, Pradthana Ounchanum, Ussanee Srirompotong, Watsamon Jantarabenjakul, Jiratchaya Sophonphan, Sunti Punnahitanon, Chitsanu Pancharoen, Tim R. Cressey, Kulkanya Chokephaibulkit, Thanyawee Puthanakit
Format: Journal
Published: 2020
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/67965
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Institution: Chiang Mai University
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spelling th-cmuir.6653943832-679652020-04-02T15:12:36Z Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants Suvaporn Anugulruengkitt Piyarat Suntarattiwong Pradthana Ounchanum Ussanee Srirompotong Watsamon Jantarabenjakul Jiratchaya Sophonphan Sunti Punnahitanon Chitsanu Pancharoen Tim R. Cressey Kulkanya Chokephaibulkit Thanyawee Puthanakit Medicine © 2019 Pediatric Infectious Disease Journal. All rights reserved. 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. 2020-04-02T15:12:36Z 2020-04-02T15:12:36Z 2019-10-01 Journal 15320987 08913668 2-s2.0-85072791175 10.1097/INF.0000000000002426 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85072791175&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/67965
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
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
description © 2019 Pediatric Infectious Disease Journal. All rights reserved. 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.
format Journal
author Suvaporn Anugulruengkitt
Piyarat Suntarattiwong
Pradthana Ounchanum
Ussanee Srirompotong
Watsamon Jantarabenjakul
Jiratchaya Sophonphan
Sunti Punnahitanon
Chitsanu Pancharoen
Tim R. Cressey
Kulkanya Chokephaibulkit
Thanyawee Puthanakit
author_facet Suvaporn Anugulruengkitt
Piyarat Suntarattiwong
Pradthana Ounchanum
Ussanee Srirompotong
Watsamon Jantarabenjakul
Jiratchaya Sophonphan
Sunti Punnahitanon
Chitsanu Pancharoen
Tim R. Cressey
Kulkanya Chokephaibulkit
Thanyawee Puthanakit
author_sort Suvaporn Anugulruengkitt
title Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
title_short Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
title_full Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
title_fullStr Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
title_full_unstemmed Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants
title_sort safety of 6-week neonatal triple-combination antiretroviral postexposure prophylaxis in high-risk hiv-exposed infants
publishDate 2020
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85072791175&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/67965
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