Perinatal outcomes among pregnant women with HIV initiating antiretroviral therapy preconception and antenatally.

IF 3.4 2区医学 Q3 IMMUNOLOGY AIDS Pub Date : 2025-04-01 Epub Date: 2025-01-09 DOI:10.1097/QAD.0000000000004104

Pippa Boering, Claudia Murray, Clara Portwood, Molly Hey, Lucy Thompson, Katharina Beck, Imogen Cowdell, Harriet Sexton, Mary Kumarendran, Zoe Brandon, Shona Kirtley, Joris Hemelaar

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Abstract

Objective: Increasingly, pregnant women with HIV (WHIV) initiate antiretroviral therapy (ART) before conception. We assessed the risk of adverse perinatal outcomes among pregnant WHIV initiating ART preconception or antenatally, compared with women without HIV or ART-naive WHIV.

Design: Systematic review and meta-analysis.

Methods: We searched PubMed, EMBASE, CINAHL, and Global Health for studies published between 1 January 1980 and 14 July 2023. We assessed the association of preconception/antenatal ART initiation with preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Data were analysed using random effects meta-analyses. Quality assessments, subgroup and sensitivity analyses were conducted. PROSPERO registration: CRD42021248987.

Results: Thirty-one cohort studies were eligible, including 199 156 women in 19 countries. WHIV with preconception ART were associated with increased risk of PTB [risk ratio (RR) 1.55; 95% confidence interval (CI) 1.27-1.90], VPTB (RR 2.14, 95% CI 1.02-4.47), LBW (RR 2.19, 95% CI 1.32-3.63), VLBW (RR 3.34, 95% CI 1.08-10.35), SGA (RR 1.92, 95% CI 1.01-3.66), and VSGA (RR 2.79, 95% CI 1.04-7.47), compared with women without HIV. WHIV with antenatal ART were associated with increased risk of PTB (RR 1.35, 95% CI 1.15-1.58), LBW (RR 2.16, 95% CI 1.39-3.34), VLBW (RR 1.97, 95% CI 1.01-3.84), SGA (RR 1.77, 95% CI 1.10-2.84), and VSGA (RR 1.21, 95% CI 1.09-1.33), compared with women without HIV. Compared to ART-naive WHIV, WHIV with preconception or antenatal ART were associated with increased risk of SGA (preconception: RR 1.40, 95% CI 1.12-1.73; antenatal: RR 1.39, 95% CI 1.11-1.74) and VSGA (preconception: RR 2.44, 95% CI 1.63-3.66; antenatal: RR 2.24, 95% CI 1.48-3.40).

Conclusion: Among WHIV, both preconception and antenatal initiation of ART are associated with increased risks of adverse perinatal outcomes, compared to women without HIV and ART-naive WHIV.

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感染艾滋病毒的孕妇孕前和产前开始抗逆转录病毒治疗的围产期结局：系统回顾和荟萃分析

目的：越来越多的携带艾滋病毒（WLHIV）的孕妇在受孕前开始抗逆转录病毒治疗（ART）。与未感染艾滋病毒或ART-naïve感染艾滋病毒的孕妇相比，我们评估了孕前或产前开始抗逆转录病毒治疗的孕妇不良围产期结局的风险。设计：系统回顾和荟萃分析。方法：我们检索PubMed、EMBASE、CINAHL和Global Health在1980年1月1日至2023年7月14日期间发表的研究。我们评估了孕前/产前ART启动与早产（PTB）、重度PTB （VPTB）、自发性PTB （sPTB）、低出生体重（LBW）、重度LBW （VLBW）、小胎龄（SGA）、重度SGA （VSGA）、死产和新生儿死亡（NND）的关系。数据分析采用随机效应荟萃分析。进行质量评价、亚组分析和敏感性分析。普洛斯彼罗注册：CRD42021248987。结果：31项队列研究符合条件，包括19个国家的199,156名妇女。WLHIV合并孕前抗逆转录病毒治疗与PTB风险增加相关(风险比1.55；95%CI 1.27-1.90), VPTB (2.14,1.02-4.47), LBW (2.19, 1.32-3.63), VLBW (3.34, 1.08-10.35), SGA (1.92, 1.01-3.66)， VSGA（2.79, 1.04-7.47）。与未感染艾滋病毒的妇女相比，接受产前抗逆转录病毒治疗的妇女患PTB（1.35, 1.15-1.58）、LBW（2.16, 1.39-3.34）、VLBW（1.97, 1.01-3.84）、SGA（1.77, 1.10-2.84）和VSGA（1.21, 1.09-1.33）的风险增加。与ART-naïve WLHIV相比，WLHIV伴孕前或产前ART与SGA风险增加相关(孕前：1.40,1.12-1.73；产前：1.39,1.11-1.74)和VSGA(孕前：2.44,1.63-3.66；产前：2.24,1.48-3.40)。结论：与未感染艾滋病毒和ART-naïve感染艾滋病毒的妇女相比，孕前和产前开始抗逆转录病毒治疗与不良围产期结局的风险增加有关。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.