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HIV Drug Combination can Cause Adrenal Dysfunction in Infants
"The HIV-l transmission rate to newborns is now less than 1 percent for women treated during pregnancy. For pregnant women not optimally treated, as in cases of HIV diagnosis late during pregnancy or persistent viral replication at delivery, several guidelines, observational reports, and the results of a recent controlled study suggest reinforcing the postnatal phase of treatment with a combination of anti-retrovirals, as a 'postexposure prophylaxis.' The protease inhibitor lopinavir, with its pharmacological booster ritonavir (lopinavir-ritonavir), is now the ritonavir-boosted protease inhibitor most widely prescribed in children," according to background information in the article.
Lopinavir-ritonavir is licensed in the United States for HIV-infected newborns older than 14 days and in Europe for children older than 2 years. However, published data concerning its use in newborns are scarce. In April 2010, one of the centers of the French national screening program for congenital adrenal hyperplasia (CAH; a group of inherited disorders of the adrenal glands) identified a transient increase of 17-hydroxyprogesterone (17OHP; a steroid hormone produced mainly by the adrenal glands) in dried blood spots from 2 children treated at birth with lopinavir-ritonavir.
Albane Simon, M.D., of the Hopital Necker-Enfants Maiades, Assistance Publique-Hopitaux de Paris, France, and colleagues conducted a study to assess whether immediate postnatal exposure to lopinavir-ritonavir was associated with changes in adrenal function compared with standard prophylactic zidovudine treatment. The study included information from the database of the national screening for congenital adrenal hyperplasia and the French Perinatal Cohort, with a comparison of HIV-1-uninfected newborns postnatally treated with lopinavir-ritonavir and controls treated with standard zidovudine. There was an assessment of levels of 17OHP and dehydroepiandrosterone-sulfate (DHEA-S; the circulating form of a steroid produced primarily by the adrenal cortex) concentrations during the first week of treatment.
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