Sibiude Jeanne, Warszawski Josiane, Blanche Stéphane
Hôpital Louis Mourier, Service de Gynécologie et d'Obstétrique, Assistance Publique -Hôpitaux de Paris (APHP) , Colombes , France.
Expert Opin Drug Saf. 2015 May;14(5):643-54. doi: 10.1517/14740338.2015.1019462. Epub 2015 Mar 1.
The prevention of mother-to-child HIV-1 transmission by antiretroviral drug treatment is remarkably effective. The risk of transmission to the child is now almost zero for women optimally treated during pregnancy. The rapid expansion of this prophylactic treatment has led the World Health Organization to aspire to the virtual elimination of mother-to-child transmission and pediatric AIDS over the next few years. In 2014, more than 900,000 women worldwide were treated with antiretroviral drugs during pregnancy. The issue of fetal and neonatal antiretroviral drug tolerance is therefore extremely important.
This review focuses on the possible impact of in utero exposure to antiretroviral drug on newborn health. To restrict analysis to this period is justified by the specificities of transplacental drug exposure and fetal vulnerability. Relevant data are available from trials and observational cohorts. The significance of various bio-markers detectable at birth is still unresolved, but merits a careful evaluation. Long-term assessment is associated with various logistical difficulties.
The health of 'exposed but not infected' children poses no major problem in the immense majority of cases, but a series of biological, clinical and imaging-based warning signs have emerged indicating the need for careful attention to be paid to this issue. Some effects that are straightforward to manage in industrialized countries may have more severe consequences in countries in which access to effective healthcare is limited. Nucleoside/nucleotide analogs are potentially genotoxic to mitochondrial and nuclear DNA, and the principal question to be addressed concerns their potential long-term effects.
通过抗逆转录病毒药物治疗预防母婴HIV-1传播非常有效。对于孕期接受最佳治疗的女性，将病毒传播给孩子的风险现在几乎为零。这种预防性治疗的迅速扩大使世界卫生组织渴望在未来几年内实现母婴传播和儿童艾滋病的实际消除。2014年，全球超过90万孕妇在孕期接受了抗逆转录病毒药物治疗。因此，胎儿和新生儿对抗逆转录病毒药物的耐受性问题极其重要。
本综述重点关注子宫内接触抗逆转录病毒药物对新生儿健康可能产生的影响。鉴于经胎盘药物暴露和胎儿易感性的特殊性，将分析限制在这一时期是合理的。相关数据可从试验和观察性队列研究中获得。出生时可检测到的各种生物标志物的意义仍未明确，但值得仔细评估。长期评估存在各种后勤方面的困难。
在绝大多数情况下，“暴露但未感染”儿童的健康不存在重大问题，但已经出现了一系列基于生物学、临床和影像学的警示信号，表明需要对此问题予以密切关注。一些在工业化国家易于处理的影响，在获得有效医疗保健有限的国家可能会产生更严重的后果。核苷/核苷酸类似物可能对线粒体和核DNA具有潜在的遗传毒性，需要解决的主要问题涉及其潜在的长期影响。
