title: In Utero Exposure to Antiretroviral Drugs: Effect on Birth Weight and Growth Among HIV-exposed Uninfected Children in Brazil.
abstract: BACKGROUND
  There are concerns about the effects of in utero exposure to antiretroviral drugs (ARVs) on the development of HIV-exposed but uninfected (HEU) children. The aim of this study was to evaluate whether in utero exposure to ARVs is associated with lower birth weight/height and reduced growth during the first 2 years of life.
  
  
  METHODS
  This cohort study was conducted among HEU infants born between 1996 and 2010 in Tertiary children's hospital in Rio de Janeiro, Brazil. Weight was measured by mechanical scale, and height was measured by measuring board. Z-scores for weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length were calculated. We modeled trajectories by mixed-effects models and adjusted for mother's age, CD4 cell count, viral load, year of birth and family income.
  
  
  RESULTS
  A total of 588 HEU infants were included of whom 155 (26%) were not exposed to ARVs, 114 (19%) were exposed early (first trimester) and 319 (54%) later. WAZ were lower among infants exposed early compared with infants exposed later: adjusted differences were -0.52 (95% confidence interval [CI]: -0.99 to -0.04, P = 0.02) at birth and -0.22 (95% CI: -0.47 to 0.04, P = 0.10) during follow-up. LAZ were lower during follow-up: -0.35 (95% CI: -0.63 to -0.08, P = 0.01). There were no differences in weight-for-length scores. Z-scores of infants exposed late during pregnancy were similar to unexposed infants.
  
  
  CONCLUSIONS
  In HEU children, early exposure to ARVs was associated with lower WAZ at birth and lower LAZ up to 2 years of life. Growth of HEU children needs to be monitored closely.
authors.affiliation: From the *Department of Preventive Medicine, Universidade Federal do Rio de Janeiro; †Pediatrics Department, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; ‡Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; and §School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Cristina Barroso
authors.initials: CB
authors.lastname: Hofer
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
authors.forename: Marcel
authors.initials: M
authors.lastname: Zwahlen
authors.forename: Carla Sepulveda
authors.initials: CS
authors.lastname: Lustosa
authors.forename: Ana Cristina Cisne
authors.initials: AC
authors.lastname: Frota
authors.forename: Ricardo Hugo
authors.initials: RH
authors.lastname: de Oliveira
authors.forename: Thalita F
authors.initials: TF
authors.lastname: Abreu
authors.forename: Alice Weber
authors.initials: AW
authors.lastname: Carvalho
authors.forename: Lucia Evangelista
authors.initials: LE
authors.lastname: Araujo
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002657:Child Development; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D011297:Prenatal Exposure Delayed Effects; D062486:Public Health Surveillance; D012307:Risk Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents