Journal Article

Hematological Changes in Women and Infants Exposed to an AZT-Containing Regimen for Prevention of Mother-to-Child-Transmission of HIV in Tanzania

Kunz, Andrea, Lau, Inga, Harms, Gundel, Hauser, Andrea, Theuring, Stefanie, Dugange, Festo, Ziske, Judith, Sewangi, Julius, Kirschner, Wolf

2013

Overview

Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend an antiretroviral combination regimen involving zidovudine (AZT) during pregnancy, single-dosed nevirapine at labor onset, AZT plus Lamivudine (3TC) during delivery, and AZT/3TC for 1-4 weeks postpartum. As drug toxicities are a relevant concern, we assessed hematological alterations in AZT-exposed women and their infants. A cohort of HIV-positive women, either with AZT intake (n = 82, group 1) or without AZT intake (n = 62, group 2) for PMTCT during pregnancy, was established at Kyela District Hospital, Tanzania. The cohort also included the infants of group 1 with an in-utero AZT exposure ≥4 weeks, receiving AZT for 1 week postpartum (n = 41), and infants of group 2 without in-utero AZT exposure, receiving a prolonged 4-week AZT tail (n = 58). Complete blood counts were evaluated during pregnancy, birth, weeks 4-6 and 12. For women of group 1 with antenatal AZT intake, we found a statistically significant decrease in hemoglobin level, red blood cells, white blood cells, granulocytes, as well as an increase in red cell distribution width and platelet count. At delivery, the median red blood cell count was significantly lower and the median platelet count was significantly higher in women of group 1 compared to group 2. At birth, infants from group 1 showed a lower median hemoglobin level and granulocyte count and a higher frequency of anemia and granulocytopenia. At 4-6 weeks postpartum, the mean neutrophil granulocyte count was significantly lower and neutropenia was significantly more frequent in infants of group 2. AZT exposure during pregnancy as well as after birth resulted in significant hematological alterations for women and their newborns, although these changes were mostly mild and transient in nature. Research involving larger cohorts is needed to further analyze the impact of AZT-containing regimens on maternal and infant health.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / AIDS / Anemia / Anti-HIV Agents - administration & dosage / Anti-HIV Agents - pharmacology / Antiretroviral agents / Antiretroviral drugs / Birth / Blood / Blood Cell Count / Blood cells / Blood tests / Childbirth & labor / Disease transmission / Drug delivery systems / Drug Therapy, Combination / Erythrocytes / Exposure / Female / Hematocrit / Hematologic Diseases - chemically induced / Hematologic Diseases - prevention & control / Hematologic Tests / Hematology / Hemoglobin / Hemoglobins / Hemoglobins - analysis / Highly active antiretroviral therapy / HIV / HIV Infections - drug therapy / HIV Infections - prevention & control / HIV Infections - transmission / HIV-1 - drug effects / HIV-1 - genetics / Human immunodeficiency virus / Humans / Impact analysis / Infant / Infant, Newborn / Infants / Infectious Disease Transmission, Vertical - prevention & control / Intrauterine exposure / Lamivudine / Leukocytes / Leukocytes (granulocytic) / Medicine / Mothers / Neonates / Neutropenia / Nevirapine / Platelets / Postpartum / Pregnancy / Pregnancy Complications, Infectious - drug therapy / Pregnancy Complications, Infectious - prevention & control / Pregnancy Outcome / Prenatal Exposure Delayed Effects - prevention & control / Prevention / Statistical analysis / Tanzania / Toxicity / Womens health / Young Adult / Zidovudine / Zidovudine - administration & dosage / Zidovudine - pharmacology