OBJECTIVE: To study the impact on the neonate of maternal antiretroviral therapy with atazanavir (ATV). STUDY DESIGN: An observational study of 22 HIV-infected women receiving, for clinical indications, antiretroviral therapy with ATV 300 mg and ritonavir 100mg during pregnancy and their 23 HIV infants (including a twin pair). RESULTS: Mothers had received ATV for a median duration of 19 months [range 3-49] by delivery. At delivery, plasma HIV-RNA was <40 copies/mL in all patients. Liver enzymes were normal in 19/22 patients, but one woman had grade 3-4 liver toxicity. Maternal serum bilirubin concentrations were above the upper limit of normal in most patients, with grade 3 toxicity in 5 patients. All but one woman had trough ATV concentrations during pregnancy above the minimum effective concentration. The median cord blood ATV concentration was 130 ng/mL [range<30-758]; the cord/maternal ratio was 21%. All neonates were born at term [median 38.2 weeks]. Three neonates had mildly elevated AST transaminase levels. Bilirubin concentrations at birth were significantly higher than maternal concentrations, with a median of 44 μm/L [range 24-129]; values on days 2-3 were 63 [8-212]. Five neonates had jaundice requiring phototherapy, without liver damage, and recovered without sequelae. CONCLUSION: Neonates whose mothers were treated with ATV should be monitored for hyperbilirubinemia, which may be due to placental transfer of unconjugated bilirubin from the mother and/or a direct effect of transplacental ATV on bilirubin metabolism in the fetus.
OBJECTIVE: To study the impact on the neonate of maternal antiretroviral therapy with atazanavir (ATV). STUDY DESIGN: An observational study of 22 HIV-infectedwomen receiving, for clinical indications, antiretroviral therapy with ATV 300 mg and ritonavir 100mg during pregnancy and their 23 HIV infants (including a twin pair). RESULTS: Mothers had received ATV for a median duration of 19 months [range 3-49] by delivery. At delivery, plasma HIV-RNA was <40 copies/mL in all patients. Liver enzymes were normal in 19/22 patients, but one woman had grade 3-4 liver toxicity. Maternal serum bilirubin concentrations were above the upper limit of normal in most patients, with grade 3 toxicity in 5 patients. All but one woman had trough ATV concentrations during pregnancy above the minimum effective concentration. The median cord blood ATV concentration was 130 ng/mL [range<30-758]; the cord/maternal ratio was 21%. All neonates were born at term [median 38.2 weeks]. Three neonates had mildly elevated AST transaminase levels. Bilirubin concentrations at birth were significantly higher than maternal concentrations, with a median of 44 μm/L [range 24-129]; values on days 2-3 were 63 [8-212]. Five neonates had jaundice requiring phototherapy, without liver damage, and recovered without sequelae. CONCLUSION: Neonates whose mothers were treated with ATV should be monitored for hyperbilirubinemia, which may be due to placental transfer of unconjugated bilirubin from the mother and/or a direct effect of transplacental ATV on bilirubin metabolism in the fetus.
Authors: Sarah K Himes; Yanling Huo; George K Siberry; Paige L Williams; Mabel L Rice; Patricia A Sirois; Toni Frederick; Rohan Hazra; Marilyn A Huestis Journal: J Acquir Immune Defic Syndr Date: 2015-06-01 Impact factor: 3.731
Authors: Carmen J Marsit; Sean S Brummel; Deborah Kacanek; George R Seage; Stephen A Spector; David A Armstrong; Barry M Lester; Kenneth Rich Journal: Epigenetics Date: 2015 Impact factor: 4.528
Authors: Ellen C Caniglia; Kunjal Patel; Yanling Huo; Paige L Williams; Suad Kapetanovic; Kenneth C Rich; Patricia A Sirois; Denise L Jacobson; Sonia Hernandez-Diaz; Miguel A Hernán; George R Seage Journal: AIDS Date: 2016-05-15 Impact factor: 4.177
Authors: Patricia A Sirois; Yanling Huo; Paige L Williams; Kathleen Malee; Patricia A Garvie; Betsy Kammerer; Kenneth Rich; Russell B Van Dyke; Molly L Nozyce Journal: Pediatr Infect Dis J Date: 2013-06 Impact factor: 2.129
Authors: Regis Kreitchmann; Brookie M Best; Jiajia Wang; Alice Stek; Edmund Caparelli; D Heather Watts; Elizabeth Smith; David E Shapiro; Steve Rossi; Sandra K Burchett; Elizabeth Hawkins; Mark Byroads; Tim R Cressey; Mark Mirochnick Journal: J Acquir Immune Defic Syndr Date: 2013-05-01 Impact factor: 3.731
Authors: Mabel L Rice; Bret Zeldow; George K Siberry; Murli Purswani; Kathleen Malee; Howard J Hoffman; Toni Frederick; Ashley Buchanan; Patricia A Sirois; Susannah M Allison; Paige L Williams Journal: Pediatr Infect Dis J Date: 2013-10 Impact factor: 2.129