Exposure to antiretroviral therapy in uninfected children born to HIV infected women in Europe
This thesis aims to investigate possible adverse side effects of antiretroviral therapy (ART) exposure in uninfected children born to HIV infected women, and to explore potential strategies for monitoring the health of these children. Using data from the European Collaborative Study, an ongoing multi-centre cohort study of HIV infected women and their children, the association between ART exposure and health outcomes in uninfected children was investigated. ART exposure was not associated with congenital abnormalities, or serious clinical symptoms up to 18 months of age. Children exposed to combination therapy were more likely to be premature than unexposed children. There was a marginal but significant negative effect of combination therapy exposure on weight, height and head circumference up to 18 months of age, when compared to no or monotherapy exposure. The CHART study, a consented clinic-based follow-up of uninfected children born in the UK, was conducted for three years to explore the feasibility of individualised follow-up to monitor adverse health events. The study was based on reports to obstetric and paediatric HIV surveillance, the National Study of HIV in Pregnancy and Childhood (NSHPC). Of 2104 eligible children, 33% were enrolled, 25% lost to follow-up, parents of 5% declined and the remainder could not be enrolled mainly because of resources or family circumstances. To obtain details on deaths and cancers among ART-exposed children over the long term, nearly 2200 uninfected children reported to the NSHPC were identified on the National Health Service Central Register through an anonymous matching procedure. Three deaths and no cancers were notified by the end of 2005. A survey of 140 parents and carers of ART-exposed uninfected children was conducted to seek their views on the long-term follow-up of their children. Although most respondents were supportive of the rationale for follow-up, contradictory views were expressed on how contact should be maintained.