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: | Trevor McBride, Kinga K. Smolen, Catherine Adler, Jack Levy, Fiona R. M. van der Klis, Tobias R. Kollmann, Tessa Goetghebuer, Arnaud Marchant, Douglas A. Lauffenburger, Edwige Haelterman, Pedro A. Piedra, Galit Alter, Jishnu Das, Gaby Smits, Sandra Lecomte, Patricia Barlow |
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| Přispěvatelé: | Massachusetts Institute of Technology. Department of Biological Engineering |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Microbiologie et protistologie [parasitologie hum. et anim.] Pediatrics medicine.medical_specialty 030106 microbiology immune activation 03 medical and health sciences 0302 clinical medicine maternal HIV Epidemiology medicine 030212 general & internal medicine Prospective cohort study Pathologie maladies infectieuses Pregnancy Fetus business.industry Risk of infection Hazard ratio anti-retroviral therapy infant infections medicine.disease Confidence interval Microbiologie et protistologie [entomologie phytoparasitolog.] Infectious Diseases maternal antibodies Relative risk business Microbiologie et protistologie [bacteriol.virolog.mycolog.] |
| Zdroj: | Clinical infectious diseases, 68 (7 Prof. Lauffenberger via Howard Silver |
| Popis: | 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. SCOPUS: ar.j info:eu-repo/semantics/published |
| Databáze: | OpenAIRE |
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