Safety of efavirenz in the first trimester of pregnancy

Ford, Nathan; Mofenson, Lynne; Shubber, Zara; Calmy, Alexandra; Andrieux-Meyer, Isabelle; Vitória, Marco; Shaffer, Nathan; Renaud, Françoise

doi:10.1097/qad.0000000000000231

Cited by 192 publications

(34 citation statements)

References 30 publications

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“…The effect of maternal HIV and alcohol use on gestational may be attenuated by ARTs with similar findings from several recent meta-analyses and systematic reviews showing good maternal and infant outcomes for HIV-infected mothers on ARTs [47, 48]. While such findings are positive, they do not negate the potentially harmful effects of HIV and alcohol on long-term developmental outcomes of children, which need to be explored further.…”

Section: Discussionsupporting

confidence: 52%

The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use

et al. 2017

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BackgroundThere is growing evidence of the negative impact of alcohol on morbidity and mortality of individuals living with HIV but limited evidence of in utero effects of HIV and alcohol on exposure on infants.MethodsWe conducted a population-based birth cohort study (N = 667 mother-infant dyads) in South Africa to investigate whether maternal alcohol use and HIV affected gestational outcomes. Descriptive data analysis was conducted for all variables using frequency distributions, measures of central tendency, and estimates of variance. Hierarchical multiple regression was conducted to determine whether maternal alcohol use, maternal HIV status and other risk factors (socioeconomic status, smoking, depression) predicted infant outcomes.ResultsOur results showed severity of recent alcohol use and lifetime alcohol use predicted low birth weight. Similarly lifetime alcohol use predicted shorter infant length, smaller head length, smaller head circumference, and early gestational age. However, HIV status was not a significant predictor of gestational outcomes.ConclusionsThe unexpected finding that maternal HIV status did not predict any of the gestational outcomes may be due to high rates of ART usage among HIV-infected mothers. The potentially negative effects of HIV on gestational outcomes may have been attenuated by improved maternal health due to high coverage of antiretroviral treatment in South Africa. Interventions are needed to reduce alcohol consumption among pregnant mothers and to support healthy growth and psychosocial development of infants.

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Section: Discussionsupporting

confidence: 52%

The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use

et al. 2017

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“…Several meta analyses of chemical exposures during pregnancy include but are not limited to: pollution 69 , secondhand smoke 70 , efavirenz 71 , polychlorinated biphenyls and dichlorodiphenyldichloroethylene 72 , domestic violence 73 , antidepressant use 74,75 , shift work 76 , statins 77 , and maternal obesity 78 . Many of the exposures listed were correlated with preterm birth, altered size and weight of the offspring.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms of the Maternal Exposome and Implications for Health Outcomes

Wright

Starkweather

York

2016

Advances in Nursing Science

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It is well established that the environment contributes to health. However, few studies have evaluated environmental exposures in women that may influence future health of their offspring. Knowledge gained may inform nursing how to better advocate for patients and families; and provide individualized interventions and education. Therefore, a more comprehensive investigation of the maternal exposome to uncover mechanistic insight into complex disease in offspring is warranted. To advance understanding of biological mechanisms that contribute to high-risk birth outcomes and offspring predisposition to disease, it will be necessary to measure a range of exposures and biomarkers before and during pregnancy.

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“…Previous teratogenicity concerns arose from primate studies, and there are no available direct data from human studies. However, meta-analyses of the literature have shown that first-trimester EFZ exposure is not associated with higher risk to teratogenicity [13]. Possibly following the USA’s HHS panel updates, Brazil’s Ministry of Health recently issued a similar update to its guidelines.…”

Section: Antiretroviral Drug Regimens For Hiv-1 Mother To Child Trmentioning

confidence: 99%

Antiretroviral Treatment in HIV-1-Positive Mothers: Neurological Implications in Virus-Free Children

Coelho

Tricarico

Celsi

et al. 2017

IJMS

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Since the worldwide introduction of antiretroviral therapy (ART) in human immunodeficiency virus type 1, HIV-1-positive mothers, together with HIV-1 testing prior to pregnancy, caesarian birth and breastfeeding cessation with replacement feeding, a reduction of HIV-1 mother-to-child transmission (MTCT) has been observed in the last few years. As such, an increasing number of children are being exposed in utero to ART. Several questions have arisen concerning the neurological effects of ART exposure in utero, considering the potential effect of antiretroviral drugs on the central nervous system, a structure which is in continuous development in the fetus and characterized by great plasticity. This review aims at discussing the possible neurological impairment of children exposed to ART in utero, focusing attention on the drugs commonly used for HIV-1 MTCT prevention, clinical reports of ART neurotoxicity in children born to HIV-1-positive mothers, and neurologic effects of protease inhibitors (PIs), especially ritonavir-“boosted” lopinavir (LPV/r) in cell and animal central nervous system models evaluating the potential neurotoxic effect of ART. Finally, we present the findings of a meta-analysis to assess the effects on the neurodevelopment of children exposed to ART in utero.

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Safety of efavirenz in the first trimester of pregnancy

Cited by 192 publications

References 30 publications

The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use

The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use

Mechanisms of the Maternal Exposome and Implications for Health Outcomes

Antiretroviral Treatment in HIV-1-Positive Mothers: Neurological Implications in Virus-Free Children

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