Lymphocyte subsets in HIV-exposed uninfected infants: The impact of neonatal postexposure prophylaxis with zidovudine. Open Forum of Infectious Diseases
Greiter et al. on behalf of the Swiss HIV Cohort Study and the Swiss Mother and Child HIV Cohort Study aimed to analyze the impact of zidovudine (AZT-) based neo-natal postexposure prophylaxis (PEP) on lymphocyte subsets and hematological parameters in HIV-exposed, uninfected (HEU) children from birth to 24 months of age. Postnatal AZT exposure was defined as administration of neo-natal PEP with AZT for at least 2 weeks. Lymphocyte subsets and hematological parameters were evaluated at 1, 2, 6, and 24 months of age during routine visits-
Among 178 HEU infants included in the analysis, 25 (14%) did not receive any neonatal PEP after birth. Eighty-two (53.6%) neonatal PEP recipients and 1 (4%) of the infants without PEP were born to mothers with AZT-containing cART during pregnancy (P <.001). Overall, there were no statistically significant differences in either absolute CD4 and CD8 T-cell counts or absolute CD19 B-cell counts comparing adjusted means between HEU infants who received neonatal PEP and those who did not. Although not statistically significant, a consistent trend of lower adjusted means during the first 24 months of life in HEU infants receiving neonatal PEP compared with those not receiving PEP could be observed in the performed linear multivariate mixed models, especially for absolute CD4 T cells.
In conclusion, lymphocyte subsets in HEU infants receiving neonatal PEP did not differ from those of infants not receiving PEP but did show nonsignificant trends of lower adjusted means. Even though these observations are of questionable clinical significance, it remains unclear whether the effect of postnatal AZT exposure might have an impact on the overall health of HEU infants or might contribute to the previously observed higher incidence of infection in HEU infants within their first 2 years of life. As other high-income countries may soon follow the Swiss example to omit neonatal PEP with AZT if maternal HIV plasma viral load is fully suppressed in the last trimester of pregnancy, further studies to investigate the impact of postnatal AZT exposure in larger cohorts of HEU infants should be pursued.