Preemie Problems With HIV Drug

Kaletra treatment for premature babies can cause temporary adrenal insufficiency

(RxWiki News) Premature babies can be born with a host of problems. Preemies exposed to HIV through their mothers also have even more complicated beginnings.

A recent French study finds that premature babies who are treated for in utero HIV expsure are more likely to experience adrenal insufficiency when on the HIV-prevention regimen lopinavir-ritonavir (Kaletra). These infants' adrenal function normalized after the treatment.

"If you are at risk for HIV, get tested before becoming pregnant."

Albane Simon, M.D., of the Hopital Necker-Enfants Maiades, Assistance Publique-Hopitaux de Paris, France, and colleagues report that all full-term newborns treated with Kaletra did not have any adrenal symptoms, although three premature newborns did experienced life-threatening symptoms appearing to be associated with adrenal insufficiency. All the symptoms lifted following the completion of the Kaletra treatment.

The authors summarized their findings by reporting that there is an association with Kaletra and temporary adrenal dysfunction in babies exposed to HIV-1 but not infected with the virus. Caution is suggested when prescribing this drug in premature infants.  Full-term infants on the treatment should have their electrolytes monitored during the course of treatment.

Breast milk exposure to HIV-1 in both infected or uninfected infants needs to be examined further to determine whether Kaletra is an effective and safe deterrent for infants breastfed by HIV-infected mothers.

The authors evaluated 50 HIV-1 exposed but uninfected children who received Kaletra just after birth, and 108 who received a standard treatment regimen. zidovudine (Retrovir), Retrovir and lamivudine (Epivir), or Retrovir and nevirapine (Viramune).

Among the 50 newborns treated with Kaletra, 7 (14 percent) had abnormally high 17OHP (17-hydroxyprogesterone, a steroid hormone) results from dried blood spots vs. 0 of 108 controls. For children born at term, 5 of 42 newborns treated with Kaletra vs. 0 of 93 controls had abnormally high values. Consistent with the findings for 17OHP, the DHEA-S (dehydroepiandrosterone-sulfate a form of steroid produced primarily by the adrenal cortex) values were significantly higher only in cases also exposed in utero to Kaletra.

Review Date: 
July 6, 2011