Maternal antiretroviral treatment (ART) is recommended for prevention of mother-to-child HIV-1 transmission (PMTCT). By use of this therapy mother-to-child transmission has been significantly decreased. However, antiretroviral drugs are concentrated in amniotic fluid and breast milk, raising concerns of toxicity among exposed infants. With increasing use of early maternal ART there is a need to investigate potential hematologic toxicities and their clinical relevance in infants exposed to these drugs.

A recent study was conducted within a pediatric HIV-1 vaccine trial assessing hematologic profiles of infants born to mothers receiving Antiretroviral Treatment. In this featured author interview, Dr Irene Njuguna answers questions about her research and her Retrovirology: Research and Treatment paper; Neutropenia Associated with Breastfeeding in HIV Exposed Infants:

How did you become interested in studying infant neutropenia associated with breastfeeding during antiretroviral treatment?

I was working with HIV exposed uninfected infants and noticed quite a number had neutropenia. This problem had been previously described but not in the current context of PMTCT.  Since the number of HIV exposed uninfected infants are increasing steadily in our set up, our team thought this was an important finding to document.

What was previously known about antiretroviral treatment and hematologic toxicities?

Use of antiretroviral treatment has been associated with a wide range of haematological abnormalities in infants. These abnormalities are varied, and may last 18 months after the exposure. Most of these studies have been done in non-breastfeeding populations and very few in breastfeeding populations. Among breast feeders, the long term implications of these haematological abnormalities are still unknown.

How has your work in this area advanced understanding of it?

Our work highlights the magnitude of neutropenia in the current context of PMTCT in breastfeeding populations. In addition, we also found a possible dose response relationship between breastfeeding and neutropenia that requires further evaluation.

What do regard as being the most important aspect of the results of your research?

Neutropenia is a significant problem in HIV exposed uninfected children in the current PMTCT context. Our study provides preliminary data on which further studies can be built on.  

Dr Irene Njuguna is a medical doctor with postgraduate training in tropical and infectious diseases. She is a studying physician for the Kenya Pediatric studies, a UW collaborative group conducting pediatric HIV clinical trials in Kenya. To learn more about Dr Njuguna’s research or to contact her please visit the Kenya Research Program website. Dr Njuguna’s article: Neutropenia Associated with Breastfeeding in HIV Exposed Infants is now available to download, comment on, and share.

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