Anemia y neutropenia en una cohorte de niños no infectados hijos de madres positivas para el virus de la inmunodeficiencia humana / Anaemia and neutropenia in a cohort of non-infected children of HIV-positive mothers

Introducción: Gracias a las medidas de prevención de la transmisión perinatal del virus de la inmunodeficiencia humana (VIH), la tasa de transmisión vertical actual se sitúa en torno al 1%. Los fármacos antirretrovirales usados no están exentos de efectos adversos, el más observado de los cuales es el efecto mielosupresor de la zidovudina (AZT). En este estudio pretendemos analizar la prevalencia de la anemia y la neutropenia en una cohorte de niños no infectados hijos de madres positivas para el virus de la inmunodeficiencia humana (VIH). Material y métodos: Se analizaron según protocolo estandarizado 623 niños no infectados controlados prospectivamente en la cohorte FIPSE (Fundación para la Investigación y la Prevención del Sida en España), que agrupa a 8 hospitales de la Comunidad de Madrid, así como las características y el tratamiento de las madres positivas para el VIH. Se definieron la anemia y la neutropenia según las tablas de toxicidad de los ACTG (AIDS Clinical Trails Group). Se clasificó a los niños según prematuridad, peso, origen étnico, presencia de síndrome de abstinencia y tratamiento recibido intraútero y como profilaxis en las primeras 4-6 semanas de vida. Se compararon las variables categóricas usando el test de chi al cuadrado o el test exacto de Fisher. Resultados: Un total de 188 niños (30,1 %) presentaron anemia, y 161 (25,8 %) tuvieron anemia de toxicidad de grado 2 o superior. La prematuridad (p < 0,001), el bajo peso al nacer (p = 0,005) y el tratamiento antirretroviral de gran actividad (TARGA) con inhibidores de la proteasa (p = 0,016) se asociaron con una mayor proporción de anemia. Las cifras de hemoglobina alcanzaron un nadir a las 6 semanas y se normalizaron en torno a los 6 meses. La prevalencia de neutropenia fue del 41,9 % (261 niños), y la de neutropenia moderada-grave fue del 22,7 %. La prematuridad (p = 0,01) se asoció con riesgo de neutropenia y el bajo peso influyó en la proporción de lactantes con neutropenia moderada-grave (p = 0,023). Existe una tendencia a una mayor proporción de neutropenia en los lactantes subsaharianos (el 50 % frente al 44 %), aunque esto no fue estadísticamente significativo (p = 0,12). El tipo de tratamiento recibido intraútero no influyó en el desarrollo de neutropenia. El 12,5 % de los lactantes aún presentaron neutropenia a los 18 meses de vida. El desarrollo de citopenias no se asoció con el tipo de profilaxis recibida (monoterapia, doble terapia o triple terapia). Conclusión: En nuestra serie de hijos de madres positivas para el VIH, expuestos a antirretrovirales intraútero, la proporción de casos de anemia es elevada, del 30,1 %. La prematuridad, el bajo peso al nacer y el TARGA se asociaron con una mayor proporción de anemia, que es transitoria y clínicamente poco relevante. La tasa de niños con neutropenia fue mayor (41,9 %), y se asocia con prematuridad, bajo peso y origen subsahariano. El tipo de profilaxis de la transmisión vertical empleada en los neonatos no parece influir en el desarrollo de anemia ni de neutropenia. Se observó la persistencia de la neutropenia a los 18 meses de edad, sin relevancia clínica, en un pequeño porcentaje de los niños (12,5%) (AU)

Introduction: Mother-to-child HIV transmission is currently around 1% in western countries, due to prevention measures. Antiretroviral drugs do have adverse effects, anaemia and myelosupression caused by AZT being the most observed effects. In the present study, we analyse the prevalence of anaemia and neutropenia in an uninfected children cohort born to HIV-infected women. Material and methods: We followed up 623 uninfected children belonging to the FIPSE cohort according to standardised protocols. This cohort groups 8 hospitals from Madrid and follows up HIV infected pregnant women and their children. Anaemia and neutropenia were defined according to the ACTG (AIDS Clinical Trails Group) toxicity tables. Children were classified according to prematurity, ethnic origin, birth weight, withdrawal syndrome, in-utero treatment and neonatal prophylaxis. Categorical variables were compared with the X2 or the Fisher tests. Results: Anaemia was observed in 188 (30.1 %) children during follow-up and 161 (25.8 %) had anaemia grade 2 or higher. Prematurity (p < 0.001), low birth weight (p = 0.005) and Highly Active Antiretroviral Treatment (HAART) with Protease Inhibitors (p = 0.016) were associated with higher percentages of anaemia in children. Nadir haemoglobin values were reached by 6 weeks of life and anaemia was transient and disappeared by six months of age. Neutropenia was present in 41.9 % (261 children) and 22.7% of the children had moderate-severe neutropenia. Prematurity was again associated with neutropenia (p = 0.01) and low birth weigh was associated only with moderate severe neutropenia (p = 0.023). African infants had a higher percentage of neutropenia than the rest of the children (50 % vs. 44 %), although the differences were not significant. The type of in-utero treatment did not appear to influence the neutropenia. Neutropenia was still present in 12.5 % of infants at 18 months of age. The type of neonatal prophylaxis to prevent mother-to-child transmission (monotherapy, dual therapy or triple therapy) did not influence either cytopenia. Conclusion: In our series, the proportion of children with anaemia is high: 30.1 % Prematurity, low birth weight and HAART with IP were associated with a higher proportion of anaemia, which was transient and had little clinical relevance. The proportion of children with neutropenia was higher (41.9 %) and was associated with prematurity, low birth weight and African origin. The type of neonatal prophylaxis does not seem to influence the development of cytopenias. Persistence of neutropenia (without clinical significance) was observed in a small percentage of the children 12.5 %, at 18 months of age (AU)

[Anaemia and neutropenia in a cohort of non-infected children of HIV-positive mothers]. / Anemia y neutropenia en una cohorte de niños no infectados hijos de madres positivas para el virus de la inmunodeficiencia humana.

INTRODUCTION: Mother-to-child HIV transmission is currently around 1% in western countries, due to prevention measures. Antiretroviral drugs do have adverse effects, anaemia and myelosupression caused by AZT being the most observed effects. In the present study, we analyse the prevalence of anaemia and neutropenia in an uninfected children cohort born to HIV-infected women. MATERIAL AND METHODS: We followed up 623 uninfected children belonging to the FIPSE cohort according to standardised protocols. This cohort groups 8 hospitals from Madrid and follows up HIV infected pregnant women and their children. Anaemia and neutropenia were defined according to the ACTG (AIDS Clinical Trails Group) toxicity tables. Children were classified according to prematurity, ethnic origin, birth weight, withdrawal syndrome, in-utero treatment and neonatal prophylaxis. Categorical variables were compared with the chi2 or the Fisher tests. RESULTS: Anaemia was observed in 188 (30.1%) children during follow-up and 161 (25.8%) had anaemia grade 2 or higher. Prematurity (p < 0.001), low birth weight (p = 0.005) and Highly Active Antiretroviral Treatment (HAART) with Protease Inhibitors (p = 0.016) were associated with higher percentages of anaemia in children. Nadir haemoglobin values were reached by 6 weeks of life and anaemia was transient and disappeared by six months of age. Neutropenia was present in 41.9% (261 children) and 22.7% of the children had moderate-severe neutropenia. Prematurity was again associated with neutropenia (p = 0.01) and low birth weigh was associated only with moderate-severe neutropenia (p = 0.023). African infants had a higher percentage of neutropenia than the rest of the children (50% vs. 44%), although the differences were not significant. The type of in-utero treatment did not appear to influence the neutropenia. Neutropenia was still present in 12.5% of infants at 18 months of age. The type of neonatal prophylaxis to prevent mother-to-child transmission (monotherapy, dual therapy or triple therapy) did not influence either cytopenia. CONCLUSION: In our series, the proportion of children with anaemia is high: 30.1% Prematurity, low birth weight and HAART with IP were associated with a higher proportion of anaemia, which was transient and had little clinical relevance. The proportion of children with neutropenia was higher (41.9%) and was associated with prematurity, low birth weight and African origin. The type of neonatal prophylaxis does not seem to influence the development of cytopenias. Persistence of neutropenia (without clinical significance) was observed in a small percentage of the children 12.5%, at 18 months of age.