The impact of in-utero highly active antiretroviral therapy (HAART) exposure on infant outcomes

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dc.contributor.author Van der Merwe, Karin Joan
dc.date.accessioned 2011-02-24T10:31:47Z
dc.date.available 2011-02-24T10:31:47Z
dc.date.issued 2011-02-24
dc.identifier.uri http://hdl.handle.net/10539/9087
dc.description MSc, Paediatrics and Child Health, Faculty of Health Sciences,University of the Witwatersrand en_US
dc.description.abstract Background To investigate whether in-utero exposure to highly active antiretroviral treatment (HAART) is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV infection. Methods A retrospective observational study was performed on women with CD4 cell counts ≤250 cells/mm3 attending antenatal antiretroviral clinics at two clinics in Johannesburg between October 2004 and March 2007. Low birth weight (<2.5kg) and preterm birth rates (<37 weeks) were compared in those exposed versus unexposed to HAART during pregnancy. Effects of different HAART regimen and duration (<28 weeks or ≥ 28 weeks) were assessed. Results Among HAART-unexposed infants 27% (60/224) were low birth weight (LBW) compared to 23% (90/388) of early HAART-exposed and 19% (76/407) of late HAART-exposed infants (P=0.05). In the early HAART group, older maternal age was associated with LBW and higher CD4 cell count protective against LBW (AOR 1.06, 95% CI 1.00- 1.12 and AOR 0.58, 95% CI 0.46-0.73, P<0.001, respectively). HAART-exposed infants had an increased risk of preterm birth vii (<37 weeks) (15% [138/946] versus 5% [7/147], p=0.001), with early (<28 weeks) nevirapine and efavirenz having the strongest associations with preterm birth (AOR 5.4, 95%CI 2.1-13.7, P<0.001 and AOR 5.6, 95%CI 2.1-15.2, P=0.001, respectively). Conclusion Among infants born to women with CD4 cell counts <250 cells/mm3, HAART exposure was associated with preterm birth, but not with low birth weight. More advanced immunosuppression was a significant risk factor for both LBW and preterm birth, highlighting the importance of earlier HAART initiation in pregnant women, both to optimize maternal health and to improve infant outcomes en_US
dc.language.iso en en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject HAART en_US
dc.subject in-utero en_US
dc.subject infant outcomes en_US
dc.title The impact of in-utero highly active antiretroviral therapy (HAART) exposure on infant outcomes en_US
dc.type Thesis en_US


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    Thesis (Ph.D.)--University of the Witwatersrand, 1972.

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