Objective-Results regarding potential adverse effects of antiretroviral drugs during pregnancy are discrepant and few studies, most from Europe, have provided information about pregnancy outcomes of those already on treatment at conception. The aim of this study was to investigate the impact of antiretrovirals on pregnancy outcome according to the timing of treatment initiation in relation to pregnancy in a cohort of Brazilian HIV infected pregnant women.Methods-A prospective cohort of 696 pregnancies followed-up in one single center between 1996 and 2006 was studied. Patients in receipt of antiretrovirals before pregnancy were compared with those treated after the first trimester. The outcomes evaluated were preterm delivery (PTD): < 37 weeks; severe PTD (< 34 weeks); low birth weight (LBW): < 2500 g; very LBW: < 1500 g. Results-Patients on pre-conception use of ARV had higher rates of LBW (33.3% vs. 16.5%; p = 0.0002), and a similar trend for PTD (26.3% % vs. 17.7%; p = 0.09). Stratification by type of therapy (dual vs. HAART) according to timing of initiation of ARV showed that patients in use of preconception HAART have a higher rate of PTD (20.2% vs. 10.2%, p = 0.03) and LBW (24.2% vs. 10.2%, p = 0.002). After adjusting for several factors, pre-conception HAART was associated with an increased risk for PTD (AOR: 5.0; 95% CI: 1.5 -17.0, p = 0.009) and LBW (OR: 3.6; 95% CI: 1.7 -7.7, p = 0.001).Conclusions-We identified an increased risk for LBW and PTD in patients in receipt of HAART prior to pregnancy.

clinicaltrials.gov Identifier: NCT00023452.

HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

Even on HAART, HIV-infected adolescents have lower growth parameters than the normal population and this is associated with a worse prognosis.

Background Chronic liver disease has emerged as an important problem in adults with longstanding HIV infection, but data are lacking for children. We characterized elevated aspartate aminotransferase (AST)-to-platelet ratio index (APRI ), a marker of possible liver fibrosis, in perinatally HIV-infected children. Methods NISDI [NICHD (National Institute of Child Health and Human Development) International Site Development Initiative] enrolled HIV-infected children (ages 0.1-20.1 years) from five Latin American countries in an observational cohort from 2002–2009. Twice yearly visits included medical history, physical examination and laboratory evaluations. The prevalence (95% confidence interval [CI]) of APRI>1.5 was calculated and associations with demographic, HIV-related and liver-related variables were investigated in bivariate analyses. Results APRI was available for 1012 of 1032 children. APRI was >1.5 in 32 (3.2%, 95% CI: 2.2%-4.4%) including 2 of 4 participants with hepatitis B (HBV) infection. Factors significantly associated with APRI>1.5 (p<0.01 compared to APRI≤1.5) included country, younger age, past or current HBV, higher alanine aminotransferase, lower total cholesterol, higher log10 current viral load, lower current CD4 count, lower nadir CD4 count, use of hepatotoxic non-antiretroviral (ARV) medications, and no prior ARV use. Rates of APRI>1.5 varied significantly by current ARV regimen (p=0.0002), from 8.0% for no ARV to 3.2% for non-protease inhibitor (PI) regimens to 1.5% for PI-based regimens. Conclusions Elevated APRI occurred in approximately 3% of perinatally HIV-infected children. PI-based ARVs appeared protective while inadequate HIV control appeared to increase risk of elevated APRI. Additional investigations are needed to better assess potential subclinical, chronic liver disease in HIV-infected children.