Selected hematologic and biochemical measurements in African HIV-infected and uninfected pregnant women and their infants: the HIV Prevention Trials Network 024 protocol.
BACKGROUND
Reference values for hematological and biochemical assays in pregnant women and in newborn infants are based primarily on Caucasian populations. Normative data are limited for populations in sub-Saharan Africa, especially comparing women with and without HIV infection, and comparing infants with and without HIV infection or HIV exposure.


METHODS
We determined HIV status and selected hematological and biochemical measurements in women at 20-24 weeks and at 36 weeks gestation, and in infants at birth and 4-6 weeks of age. All were recruited within a randomized clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV (HPTN024). We report nearly complete laboratory data on 2,292 HIV-infected and 367 HIV-uninfected pregnant African women who were representative of the public clinics from which the women were recruited. Nearly all the HIV-infected mothers received nevirapine prophylaxis at the time of labor, as did their infants after birth (always within 72 hours of birth, but typically within just a few hours at the four study sites in Malawi (2 sites), Tanzania, and Zambia.


RESULTS
HIV-infected pregnant women had lower red blood cell counts, hemoglobin, hematocrit, and white blood cell counts than HIV-uninfected women. Platelet and monocyte counts were higher among HIV-infected women at both time points. At the 4-6-week visit, HIV-infected infants had lower hemoglobin, hematocrit and white blood cell counts than uninfected infants. Platelet counts were lower in HIV-infected infants than HIV-uninfected infants, both at birth and at 4-6 weeks of age. At 4-6 weeks, HIV-infected infants had higher alanine aminotransferase measures than uninfected infants.


CONCLUSIONS
Normative data in pregnant African women and their newborn infants are needed to guide the large-scale HIV care and treatment programs being scaled up throughout the continent. These laboratory measures will help interpret clinical data and assist in patient monitoring in a sub-Saharan Africa context.
Mwinga
Kasonde
K
Department of Paediatrics of the University Teaching Hospital and the University of Zambia School of Medicine, and the Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. mwingak@zm.afro.who.int
Vermund
Sten H
SH
Chen
Ying Q
YQ
Mwatha
Anthony
A
Read
Jennifer S
JS
Urassa
Willy
W
Carpenetti
Nicole
N
Valentine
Megan
M
Goldenberg
Robert L
RL
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001772:Blood Cell Count; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D019829:Nevirapine / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000517:prevention & control*; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
D019380:Anti-HIV Agents; D006454:Hemoglobins; D012367:RNA, Viral; D019829:Nevirapine