The introduction of combination ART to prevent mother-to-child-transmission (MTCT) has substantially decreased MTCT rates. However, there are concerns regarding safety of ART exposure for the mother, pregnancy outcome and infant. Changing MTCT prevention guidelines, with expanded eligibility, have led to a rapid increase of ART-treated women and exposed infants in high prevalence regions.
Recent studies confirm that ART in HIV-infected mothers decreases disease progression and mortality, also after delivery. However extended duration of ART, especially HAART, during pregnancy has also been associated with premature delivery, small-for-gestational age (SGA) infants and pregnancy complications including hypertension. In the uninfected infant, ART exposure was associated with levels of hematologic and immunological markers, which, in high microbial regions, may be clinically relevant, especially in combination with premature birth and SGA. Altered mitochondrial functioning is reported in ART-exposed children although clinical implications remain difficult to discern.
The benefit of ART in the prevention of MTCT is beyond doubt, but there are reports on adverse effects on pregnancy outcome and infant currently also from high prevalence regions. Further research regarding safety is urgently required, as the number of pregnant women on ART and exposed uninfected infants is rapidly increasing.
aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
bFaculty of Medicine, University of Southampton, Southampton, UK
cDivision of Pediatric Hematology, Immunology and Infectious Diseases, Emma Children's Hospital
dDepartment of Experimental Immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Correspondence to Professor Marie-Louise Newell, MB, MSc, PhD, FMedSci, Africa Centre for Health and Population Studies, P.O Box 198 Mtubatuba, 3935 South Africa. Tel: +27 035 550 7509; fax: +27 035 550 7565; e-mail: email@example.com