Initiation of Antiretroviral Therapy Before Pregnancy Reduces the Risk of Infection-related Hospitalization in Human Immunodeficiency Virus-exposed Uninfected Infants Born in a High-income Country.

Autor:	Goetghebuer T; Department of Pediatrics, Hôpital Saint-Pierre, Brussels., Smolen KK; Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium., Adler C; Department of Pediatrics, Hôpital Saint-Pierre, Brussels., Das J; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts., McBride T; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas., Smits G; National Institute of Health and the Environment, Bilthoven, The Netherlands., Lecomte S; Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium., Haelterman E; Department of Pediatrics, Hôpital Saint-Pierre, Brussels., Barlow P; Department of Obstetrics and Gynecology, Hôpital Saint-Pierre, Brussels, Belgium., Piedra PA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.; Department of Pediatrics, Baylor College of Medicine, Houston, Texas., van der Klis F; National Institute of Health and the Environment, Bilthoven, The Netherlands., Kollmann TR; Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, Canada., Lauffenburger DA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts., Alter G; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts., Levy J; Department of Pediatrics, Hôpital Saint-Pierre, Brussels., Marchant A; Institute for Medical Immunology, Université libre de Bruxelles, Charleroi, Belgium.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 Mar 19; Vol. 68 (7), pp. 1193-1203.
DOI:	10.1093/cid/ciy673
Abstrakt:	Background: Epidemiological studies conducted in low- and high-income countries showed that infants exposed to maternal human immunodeficiency virus (HIV) have a high risk of severe infections. Immune alterations during fetal life have been proposed as a possible mechanism. Methods: This prospective study assessed the relative risk of hospitalization for infection in HIV-exposed uninfected (HEU) infants as compared to HIV-unexposed (HU) infants born in a high-income country (HIC). Markers of monocyte activation and levels of pathogen-specific antibodies were measured at birth to identify correlates of infant susceptibility. Results: There were 27 of 132 HEU infants and 14 of 123 HU infants hospitalized for infection during the first year of life (adjusted hazard ratio [aHR] 2.33, 95% confidence interval [CI] 1.10-4.97). Most of this increased risk was associated with the time of initiation of maternal antiretroviral therapy (ART). As compared to HU infants, the risk of hospitalization for infection of HEU infants was 4-fold higher when mothers initiated ART during pregnancy (aHR 3.84, 95% CI 1.69-8.71) and was not significantly increased when ART was initiated before pregnancy (aHR 1.42, 95% CI 0.58-3.48). The activation of newborn monocytes and the reduced transfer of maternal antibodies were most intense following ART initiation during pregnancy, and predicted the risk of infant hospitalization. Conclusions: These observations indicate that initiation of maternal ART before pregnancy reduces the susceptibility of HEU infants born in a HIC to severe infections, and that this effect could be related to the prevention of immune alterations during fetal life. (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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