Bilateral oblique facial clefts and extremity anomaly in an infant after intrauterine efavirenz exposure and review of its teratogenic risk.
OBJECTIVE
Congenital anomalies may be caused by genetic or environmental factors or a combination of both. Oblique facial clefts are very rare congenital deformities. The occurrence of facial clefts and an extremity anomaly suggests a common underlying cause. Lateral oro-ocular clefts do not occur along normal developmental planes and may be part of the amnion disruption complex sequence. Our objective was to report a case of this very event, which also followed an unusual intrauterine exposure and review the literature on the teratogenic risk of efavirenz.


METHODS
We report a case of amniotic rupture sequence after fetal HIV and antiretroviral exposure.


RESULTS
Teratogenic exposure has been rarely reported and never after antiretroviral exposure.


CONCLUSIONS
By reporting and registering more cases, we will be able to better assess the risks such medications pose to the developing fetus. The publication of a single case report has the potential to contribute to our knowledge of the significance of prenatal exposure to antiretrovirals and other medications for common HIV-associated disorders. It also generates a hypothesis that can be tested with further clinical data, animal models and epidemiologic studies.
Center for Craniofacial Disorders, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA. ashanske@aol.com
Alan L
AL
Shanske
D000014:Abnormalities, Drug-Induced / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects*; D016241:Child of Impaired Parents; D002972:Cleft Palate / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D003394:Craniofacial Dysostosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D003521:Cyclopropanes; D005124:Eye Abnormalities / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D019767:Maxillofacial Abnormalities / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011859:Radiography; D013723:Teratogens
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D013723:Teratogens; C098320:efavirenz