In the European Collaborative Study, perinatal ARV exposure of HIV‐exposed but uninfected children was associated with a reduced neutrophil count through age 8 years, regardless of race or sex; maternal immune status was only marginally associated with infant neutrophil counts in uninfected children. In a separate analysis, the total lymphocyte count was significantly lower in uninfected infants with perinatal exposure to ARV drugs than in those without exposure to ARV drugs; the CD4+ cell count was lower only during the first year of life, but the CD8+ count was reduced through age 8 years. However, there was no significant difference between infants who were exposed to ARV drugs, compared with those who were not, in the incidence of lymphopenia, defined as CDC immune stage 2. A lower maternal CD4+ cell count ( Acomplia diet pills
Similar to the 2 other reports, our analysis of the WITS cohort found significantly lower platelet, total lymphocyte, CD4+, and CD8+ cell counts in uninfected infants with exposure to ARV drugs than in those without exposure, and these differences persisted through age 24 months. Our data also demonstrate that the maternal immune status is associated with infant CD4+ cell counts. The mechanism by which maternal immune status might affect infant lymphocyte parameters is not clear. There have been suggestions that an immunodeficient mother may have defective transplacental transfer of hematopoietic cytokines, resulting in long‐term consequences for the thymic output of CD4+ cells in the child. Additional studies are needed to elucidate this effect further.
However, unlike the European studies, although exposure to ARV combination was associated in WITS with a stronger effect on these parameters during the first 2 months of life, this potentiating effect of combination, compared with exposure to ARV monotherapy, persisted through age 24 months only for CD8+ cell count and not for platelet, total lymphocyte, or CD4+ cell counts. Additionally, in contrast to the French and European cohorts, in WITS, the effect of exposure to ARV drugs on neutrophil count did not remain significant after age 2 months.
A recent study from Amsterdam compared hematologic parameters in 92 uninfected, HIV‐exposed children, all but a few of whom had mothers who had received 3 ARV drugs during pregnancy and all of whom received combination zidovudine/lamivudine therapy for the first 4 weeks of life, with those in 75 children matched for gestational age, sex, and ethnicity who were born to HIV‐uninfected women. Like WITS and the other studies, differences in hemoglobin concentration were transient. Those researchers reported significantly lower neutrophil counts in the HIV‐ and ARV‐exposed infants than in infants born to uninfected women through age 8 months. However, similar to the WITS analyses, these differences did not persist through age 20 months. By contrast, significant differences in platelet and absolute lymphocyte counts were not found in this considerably smaller cohort.