Haematological effects of zidovudine prophylaxis in newborn infants with and without prenatal exposure to zidovudine

Silvia Baroncelli (1) , Carmela Pinnetti (2) , Orazio Genovese (3) , Enrica Tamburrini (2) , Marco Floridia (4)

1 Department of Therapeutic Research and Medicines Evaluation
2 Department of Infectious Diseases
3 Department of Paediatrics
4 Department of Therapeutic Research and Medicines Evaluation

ABSTRACT Postnatal prophylaxis with oral zidovudine (ZDV) is associated with haematological effects. However, it is still unknown whether selection of non-ZDV based regimens in pregnancy may reduce haematological toxicity associated with postnatal ZDV prophylaxis. The aim of this study was to define the haematological effects of zidovudine prophylaxis in newborns with and without prenatal exposure to ZDV. Sixty-five newborns from mothers infected with HIV who, during pregnancy, received HAART regimens with (n:44) and without (n: 21) ZDV were evaluated. Virological and haematological data were compared at birth and at four weeks and six months of life. Newborns with prenatal ZDV exposure had significantly worse haematological values at birth, with lower levels of haemoglobin (14.3 vs. 16.2 g/dl, p=0.001), red blood cell count (3.45 vs. 4.48 x106 cells/mm3, p<0.001), and haematocrit (41.0 vs. 46.8%, p<0.001), and higher values of mean corpuscular volume (119 vs. 103 fl, p<0.001). The start of ZDV prophylaxis determined significantly greater adverse haematological changes in newborns without prenatal ZDV exposure, and at four weeks and six months of life the two groups had substantially identical haematological values. The selection of non-ZDV based regimens in pregnancy does not reduce the final haematological effects of postnatal ZDV at four weeks and at six months of life. However, two distinct pathways may be observed: newborns exposed prenatally to ZDV have worse haematological values at birth, while newborns without prenatal ZDV exposure have particularly marked postnatal effects. The distinct effects of these two pathways should be considered.

Mots clés: Medicine

Silvia Baroncelli, Carmela Pinnetti, Orazio Genovese, Enrica Tamburrini, Marco Floridia. Haematological effects of zidovudine prophylaxis in newborn infants with and without prenatal exposure to zidovudine. Journal of Medical Virology, 2011, 83 (3), pp.551. ⟨10.1002/jmv.21986⟩. ⟨hal-00610726⟩