Ayotunde James1, Babatunde Oluwatosin2, Georgina Njideka3, Onyekwere George Benjamin1, David Olufemi3, Robert Leo4, Isaac Folorunso5, Olusegun Olusina6. 1. Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Nigeria. 2. Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria. 3. Department of Virology, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS). 4. Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA. 5. Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS). 6. Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria ; MEDICAL EDUCATION PARTNERSHIP IN NIGERIA ; PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF - AIDS PREVENTION INITIATIVE NIGERIA (PEPFAR-APIN PLUS).
Abstract
AIMS: Cleft lip/palate, though rare, is the commonest head and neck congenital malformation. Both genetic and environmental factors have been implicated in the aetiopathogenesis but the role of in-utero exposure to human immunodeficiency virus (HIV) and highly active antiretroviral therapy (HAART) is still being investigated. This short communication reports the occurrence of cleft palate in three newborns exposed in-utero to HIV and HAART. MATERIAL AND METHODS: This is a case series of HIV-exposed newborns observed to have cleft palate among a larger cohort of HIV-exposed and unexposed newborns in a study evaluating the effect of HIV infection and HAART on newborn hearing. The Risk Ratio (RR) was calculated to detect a potential association between in-utero exposure to Efavirenz containing ART and cleft palate. RESULTS: Three HIV-exposed newborns with cleft palate were identified during hearing screening performed on 126 HIV-exposed and 121 HIV unexposed newborns. Two had exposure to tenofovir+lamivudine+efavirenz (TDF+3TC+EFV) while the third had exposure to zidovudine+lamivudine+nevirapine (ZDV+3TC+NVP) during the first trimester. There was no statistically significant association between presence of cleft palate and exposure to an EFV containing HAART regimen (p=0.07, RR=10.95 [0.94-126.84]). CONCLUSIONS: This communication highlights the possible aetiologic role of HAART in cleft palate, the need for further prospective follow-up studies and establishment of antiretroviral pregnancy, birth and neonatal registries.
AIMS: Cleft lip/palate, though rare, is the commonest head and neck congenital malformation. Both genetic and environmental factors have been implicated in the aetiopathogenesis but the role of in-utero exposure to human immunodeficiency virus (HIV) and highly active antiretroviral therapy (HAART) is still being investigated. This short communication reports the occurrence of cleft palate in three newborns exposed in-utero to HIV and HAART. MATERIAL AND METHODS: This is a case series of HIV-exposed newborns observed to have cleft palate among a larger cohort of HIV-exposed and unexposed newborns in a study evaluating the effect of HIV infection and HAART on newborn hearing. The Risk Ratio (RR) was calculated to detect a potential association between in-utero exposure to Efavirenz containing ART and cleft palate. RESULTS: Three HIV-exposed newborns with cleft palate were identified during hearing screening performed on 126 HIV-exposed and 121 HIV unexposed newborns. Two had exposure to tenofovir+lamivudine+efavirenz (TDF+3TC+EFV) while the third had exposure to zidovudine+lamivudine+nevirapine (ZDV+3TC+NVP) during the first trimester. There was no statistically significant association between presence of cleft palate and exposure to an EFV containing HAART regimen (p=0.07, RR=10.95 [0.94-126.84]). CONCLUSIONS: This communication highlights the possible aetiologic role of HAART in cleft palate, the need for further prospective follow-up studies and establishment of antiretroviral pregnancy, birth and neonatal registries.
Entities:
Keywords:
Cleft palate; efavirenz; highly active antiretroviral therapy (HAART); human immunodeficiency virus (HIV); nevirapine; newborns
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