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2.08.2013

Prenatal Antiretroviral Therapy Does Not Affect Growth, UM Researchers Find

Miller School pediatrics researchers have found that exposure to antiretroviral therapy in the womb does not adversely impact growth, a finding that supports the use of the potent drugs to block the transmission of HIV/AIDS from pregnant women to their newborn children.

In the study published online January 28 in advance of print in The Journal of Pediatrics, senior author Tracie L. Miller, M.D., professor of pediatrics, Associate Chair of Pediatrics for Clinical Research, and Director of the Division of Clinical Research, and her team found no statistical growth differences between children who received antiretroviral therapy (ARV) prenatally and were born uninfected to mothers with HIV/AIDS, and a demographically matched group of children who were not exposed to HIV, nor the drugs that have dramatically reduced the mother-to-child transmission rate.

“Our study shows the importance of comparing growth among demographically similar infants rather than to national standards of infant growth, which might inaccurately suggest that in utero exposure to ARVs or HIV leads to growth disturbances,” said Miller, who is also co-director of the Miami Center for Research Participation and Partnership component of the Clinical and Translational Science Institute (CTSI). “Although long-term studies on the safety of in utero exposures to ARVs are not yet complete, it is encouraging to find that, in this cohort of infants, growth was not affected by exposure to these drugs that are highly effective in preventing mother-to-child transmission of HIV.”

In the study, “Growth and Body Composition of Uninfected Children Exposed to Human Immunodeficiency Virus: Comparison with a Contemporary Cohort and United States National Standards,” the researchers specifically found that children exposed to HIV and ARVs in utero had lower, but still normal, birth weights than the non-exposed children to whom they were compared. The exposed children also showed a pattern of slightly accelerated growth during their first two years of life.

“These findings of lower but normal birth weights and subsequent trends toward accelerated growth…suggest that lifestyle factors may influence growth more than HIV and ARVs,” the authors wrote, noting that uninfected but exposed children were often born to women of lower socioeconomic status and with a higher prevalence of smoking and illicit drug use.

For the study, researchers from the Batchelor Children’s Research Institute and the Division of Infectious Diseases and Immunology measured and compared 111 exposed but uninfected children under age 2 at UM’s HIV Screening Program to 82 gender- and age-matched unexposed children with similar socioeconomic characteristics. Members of the comparison group were recruited from UM’s general pediatric outpatient practice and five nearby urban day-care centers. The HIV-exposed children were measured periodically for weight, length, head circumference, skinfold thicknesses, and arm and thigh circumference through 2 years of age.

In their analysis, the researchers found that uninfected children who were or were not exposed to HIV had similar growth and body composition, with two differences: The uninfected children exposed to HIV were lighter at birth and showed a pattern of slightly accelerated growth in their first two years; they also had less subcutaneous fat and decreasing mid-upper arm circumference over time when compared with U.S. standards.

“We did not find statistical differences in classical and regional growth measures between the 2 groups in a cross-sectional analysis,” the authors wrote. “Clinicians and investigators who care for and study this expanding population of children exposed to HIV should be careful not to attribute changes in growth and body composition to HIV-specific factors without first carefully evaluating non-HIV covariates.”

Miller’s study co-authors include first author Daniela Neri, R.D., M.S., pediatric dietician; Gabriel Somarriba, D.P.T., assistant professor of clinical pediatrics; Natasha N. Schaefer, B.S., research associate; Aida I. Chaparro, M.D., assistant professor of pediatrics; Gwendolyn B. Scott, M.D., professor of pediatrics and Director of the Division of Pediatric Infectious Diseases and Immunology; Gabriela Lopez-Mitnik, M.S., M.Phil., senior research associate; and David A. Ludwig, Ph.D., professor of pediatrics.

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