| Anemiaa |
Principally ZDV |
Onset:
Variable, weeks to months
Presentation:
Most commonly asymptomatic or mild fatigue, pallor, tachypnea;
rarely, congestive heart failure
|
HIV-exposed newborns:
Severe anemia uncommon, but may be seen coincident with physiologic Hgb nadir
HIV-infected children on ARVs:
2–3 times more common with ZDV-containing regimens; less frequent with currently recommended dosing of ZDV
|
HIV-exposed newborns:
Premature birth
In utero exposure to ARVs
Advanced maternal HIV
Neonatal blood loss
Concurrent ZDV + 3TC neonatal prophylaxis
HIV-infected children on ARVs:
Underlying hemoglobinopathy (sickle cell disease, G6PD deficiency)
Myelosuppressive drugs (e.g., TMP-SMX, rifabutin)
Iron deficiency
Advanced or poorly controlled HIV disease
|
HIV-exposed newborns:
Monitor CBC at birth.
Consider repeat CBC at 4 weeks for neonates who are at higher risk (such as those born prematurely or known to have low birth Hgb).
HIV-infected children on ARVs:
Avoid ZDV in children with moderate to severe anemia when alternative agents are available.
Monitor CBC 3–4 times per year as part of routine care.
|
HIV-exposed newborns:
Rarely require intervention unless Hgb is <7.0 g/dL or anemia is associated with symptoms.
Consider discontinuing ZDV if 4 weeks or more of 6-week ZDV prophylaxis regimen are already completed (see Perinatal Guidelinesb).
HIV-infected children on ARVs:
Discontinue non-ARV marrow-toxic drugs, if feasible.
Treat coexisting iron deficiency, OIs, malignancies.
For persistent severe anemia thought to be associated with ARVs,
change to a non-ZDV-containing regimen; consider a trial of erythropoietin.
|
| Neutropeniaa |
Principally
ZDV |
Onset:
Variable
Presentation:
Most commonly asymptomatic
|
HIV-exposed newborns:
Rare
HIV-infected children on ARVs:
9.9%–26.8% of children on ARVs, depending upon the ARV regimen
Highest rates with ZDV-containing regimens
|
HIV-exposed newborns:
In utero exposure to ARVs
Concurrent ZDV + 3TC neonatal prophylaxis
HIV-infected children on ARVs:
Advanced or poorly controlled HIV infection
Myelosuppressive drugs (such as TMP-SMX, ganciclovir, hydroxyurea, rifabutin)
|
HIV-infected children on ARVs:
Monitor CBC 3–4 times per year as part of routine care. |
HIV-exposed newborns:
No established threshold for intervention; some experts would consider using an alternative NRTI for prophylaxis if ANC <500 cells/μL, or discontinue ARV prophylaxis entirely if ≥4 weeks of 6-week ZDV prophylaxis have been completed (see Perinatal Guidelinesb).
HIV-infected children on ARVs:
Discontinue non-ARV marrow-toxic drugs if feasible.
Treat coexisting OIs, malignancies.
For persistent severe neutropenia thought to be associated with ARVs, change to a non-ZDV-containing regimen; consider a trial of G-CSF.
|