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Exposure To Antiretrovirals During Pregnancy Does Not Alter Bone Development Of Infants

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Published: Nov 18, 2011 11:26 am
Exposure To Antiretrovirals During Pregnancy Does Not Alter Bone Development Of Infants

Results from a recent small Italian study indicate that exposure to antiretroviral drugs, including Viread, during pregnancy does not affect fetal bone metabolism and bone development.

“Antiretroviral therapy taken during pregnancy is not detrimental to bone development and bone health of the fetus/infant. Due to the awareness about the numerous side effects of antiretrovirals, we wanted to verify the safety for the fetus of the therapy,” said Dr. Stefano Mora from the Laboratory of Pediatric Endocrinology at the San Raffaele Scientific Institute of Milan, Italy, and lead author of the study.

“In simple words, HIV-infected mothers should take their therapy and do not have to worry about the bone health of their children,” he added.

Antiretroviral therapy during pregnancy is important for preventing mother-to-child transmission of HIV. However, according to the study authors, antiretrovirals have been linked to decreased bone mass and altered bone metabolism in HIV-positive children and adolescents.

Viread (tenofovir), which is also a component of Truvada (emtricitabine/tenofovir), has been particularly linked to bone loss in HIV-positive children and adults (see related AIDS Beacon news).

In this study, the researchers investigated the effect of antiretroviral drug exposure during pregnancy on newborns and infants.

The study included 38 infants who were exposed to antiretrovirals during pregnancy. The infants were born between 35 and 39 weeks of gestation. For comparison, the study also included 94 newborns with HIV-negative mothers, born between 37 and 40 weeks of gestation.

More than half (58 percent) of the HIV-positive mothers were taking two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor, and a quarter (24 percent) were taking two NRTIs and one non-nucleoside reverse transcriptase inhibitor.

The mothers received one of the following NRTI backbones: Epivir (lamivudine) plus zidovudine (Retrovir), Epzicom (abacavir/lamivudine), Epivir plus didanosine (Videx), or Truvada.

The median length of infant exposure to antiretrovirals during pregnancy was 14 weeks. All mothers had cesarean sections, and all newborns received antiretroviral therapy and were formula fed to avoid mother-to-child HIV transmission.

Measurements of bone development were obtained as soon as possible after birth and prior to hospital discharge. Further measurements were taken at follow-up visits four and 12 months after birth.

Results showed that antiretroviral-exposed infants had lower weight and length measurements at the beginning of the study and at their four-months follow-up visit, due to shorter gestation times compared to unexposed infants. However, these differences were no longer significant at age 12 months.

Ultrasound measurements of the shinbones of exposed and unexposed infants showed that there was no difference in bone quality or maturation between the two groups. Results also showed that bone formation and bone break down or loss (bone resorption) rates did not differ between the two groups.

A separate analysis showed that there were no significant differences in bone development in infants exposed to Viread or Truvada; however, the researchers noted that further studies are needed to confirm this observation.

For more information, please see the study in the journal Bone (abstract).

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