Severe haematologic toxicity is rare in high risk HIV-exposed infants receiving combination neonatal prophylaxis. HIV Medicine
The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord aimed to examine haematological toxicity in infants born to women with HIV infection at high risk of mother-to-child HIV transmission (MTCT), and specifically to identify whether neonatal prophylaxis (NP) type was associated with (1) the presence of severe or potentially life-threatening anaemia or neutropaenia within the first 6 months of life and (2) haemoglobin (Hb)level and NC at ages 0-18 months.
The study group conducted an individual patient data meta-analysis within six European cohorts, in infants at high risk for acquiring HIV infection.
Of 1’836 infants, 25% were preterm, 1’149 (63%) had antenatal combination antiretroviral therapy (cART) exposure and 395 (22%) received NP (125 received combination NP with three drugs). Overall, 117 (6.7%) infants had grade 3-4 anaemia at age 0-6 months and 140 (9.1%) had grade 3-4 neutropaenia. The presence of grade 3-4 anaemia or neutropaenia was not associated with NP type but was associated with preterm delivery. Overall, 7’746 Hb and NC results were available for 1’836 infants up to age 18 months; no significant differences in predicted Hb level or NC were apparent by NP type.
In conclusion, in this population of infants at high risk of perinatal infection born in Europe to women with uncontrolled HIV replication, NP type was not associated with severe or potentially life-threatening haematological toxicity, and combination NP appeared to be relatively safe.