Adverse perinatal outcomes associated with different classes of antiretroviral drugs in pregnant women living with HIV: a systematic review and meta-analysis.

IF 3.4 2区 医学 Q3 IMMUNOLOGY
AIDS Pub Date : 2024-10-08 DOI:10.1097/QAD.0000000000004032
Molly Hey, Lucy Thompson, Clara Portwood, Harriet Sexton, Mary Kumarendran, Zoe Brandon, Shona Kirtley, Joris Hemelaar
{"title":"Adverse perinatal outcomes associated with different classes of antiretroviral drugs in pregnant women living with HIV: a systematic review and meta-analysis.","authors":"Molly Hey, Lucy Thompson, Clara Portwood, Harriet Sexton, Mary Kumarendran, Zoe Brandon, Shona Kirtley, Joris Hemelaar","doi":"10.1097/QAD.0000000000004032","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Women living with HIV (WLHIV) are at increased risk of adverse perinatal outcomes compared to HIV-negative women, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WLHIV receiving different classes of ART, compared to HIV-negative women.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched Medline, CINAHL, Global Health and EMBASE for studies published between 1 January 1980 and 14 July 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WLHIV receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor (PI)-based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to HIV-negative women. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WLHIV receiving either NNRTI-based, PI-based or INSTI-based ART, compared with HIV-negative women. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987.</p><p><strong>Results: </strong>Of 108,720 identified citations, 22 cohort studies including 191,857 women were eligible for analysis. We found that WLHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at increased risk of PTB (risk ratio (RR) 1.40, 95% confidence interval 1.27-1.56), VPTB (1.94, 1.25-3.01), LBW (1.63, 1.30-2.04), SGA (1.53, 1.17-1.99) and VSGA (1.48, 1.16-1.87), compared with HIV-negative women. WLHIV receiving PI-based ART (mainly lopinavir/ritonavir or unspecified) are at increased risk of PTB (1.88, 1.55-2.28), VPTB (2.06, 1.01-4.18), sPTB (16.96, 1.01-284.08), LBW (2.90, 2.41-3.50), VLBW (4.35, 2.67-7.09) and VSGA (2.37, 1.84-3.05), compared with HIV-negative women. WLHIV receiving INSTI-based ART (mainly dolutegravir) are at increased risk of PTB (1.17, 1.06-1.30) and SGA (1.20, 1.08-1.33), compared with HIV-negative women.</p><p><strong>Conclusions: </strong>The risks of adverse perinatal outcomes are higher among WLHIV receiving ART compared with HIV-negative women, irrespective of the class of ART drugs. This underlines the need to further optimise ART in pregnancy and improve perinatal outcomes of WLHIV.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIDS","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAD.0000000000004032","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Women living with HIV (WLHIV) are at increased risk of adverse perinatal outcomes compared to HIV-negative women, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WLHIV receiving different classes of ART, compared to HIV-negative women.

Design: Systematic review and meta-analysis.

Methods: We searched Medline, CINAHL, Global Health and EMBASE for studies published between 1 January 1980 and 14 July 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WLHIV receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor (PI)-based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to HIV-negative women. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WLHIV receiving either NNRTI-based, PI-based or INSTI-based ART, compared with HIV-negative women. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987.

Results: Of 108,720 identified citations, 22 cohort studies including 191,857 women were eligible for analysis. We found that WLHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at increased risk of PTB (risk ratio (RR) 1.40, 95% confidence interval 1.27-1.56), VPTB (1.94, 1.25-3.01), LBW (1.63, 1.30-2.04), SGA (1.53, 1.17-1.99) and VSGA (1.48, 1.16-1.87), compared with HIV-negative women. WLHIV receiving PI-based ART (mainly lopinavir/ritonavir or unspecified) are at increased risk of PTB (1.88, 1.55-2.28), VPTB (2.06, 1.01-4.18), sPTB (16.96, 1.01-284.08), LBW (2.90, 2.41-3.50), VLBW (4.35, 2.67-7.09) and VSGA (2.37, 1.84-3.05), compared with HIV-negative women. WLHIV receiving INSTI-based ART (mainly dolutegravir) are at increased risk of PTB (1.17, 1.06-1.30) and SGA (1.20, 1.08-1.33), compared with HIV-negative women.

Conclusions: The risks of adverse perinatal outcomes are higher among WLHIV receiving ART compared with HIV-negative women, irrespective of the class of ART drugs. This underlines the need to further optimise ART in pregnancy and improve perinatal outcomes of WLHIV.

与感染艾滋病病毒的孕妇服用不同类别的抗逆转录病毒药物有关的围产期不良后果:系统综述和荟萃分析。
目的:与 HIV 阴性女性相比,尽管接受了抗逆转录病毒疗法(ART),但感染 HIV 的女性(WLHIV)围产期不良预后的风险更高。有证据表明,抗逆转录病毒疗法不同,围产期不良结局的风险也可能不同。我们旨在评估与 HIV 阴性女性相比,接受不同类别抗逆转录病毒疗法的 WLHIV 患者围产期不良结局的风险:系统回顾和荟萃分析:我们检索了 Medline、CINAHL、Global Health 和 EMBASE 中 1980 年 1 月 1 日至 2023 年 7 月 14 日期间发表的研究。我们纳入的研究评估了接受非核苷类逆转录酶抑制剂 (NNRTI) 抗逆转录病毒疗法、蛋白酶抑制剂 (PI) 抗逆转录病毒疗法或整合酶链转移抑制剂 (INSTI) 抗逆转录病毒疗法的 WLHIV 妇女与 HIV 阴性妇女相比发生 11 种预定义不良围产期结局的风险。所评估的围产期结局包括早产 (PTB)、极早产 (VPTB)、自发性早产 (sPTB)、低出生体重 (LBW)、极低出生体重 (VLBW)、足月低出生体重、早产低出生体重、小于胎龄 (SGA)、极小于胎龄 (VSGA)、死产和新生儿死亡 (NND)。随机效应荟萃分析研究了与 HIV 阴性女性相比,接受 NNRTI、PI 或 INSTI 抗逆转录病毒疗法的 WLHIV 感染各种不良结局的风险。根据国家收入状况、研究质量和开始接受抗逆转录病毒疗法的时间进行了分组分析和敏感性分析。该研究方案已在 PROSPERO 注册,注册号为 CRD42021248987:结果:在 108,720 篇已识别的引文中,有 22 项队列研究(包括 191,857 名女性)符合分析条件。我们发现,与 HIV 阴性女性相比,接受以 NNRTI 为基础的抗逆转录病毒疗法(主要是依非韦伦或奈韦拉平)的 WLHIV 患 PTB(风险比 (RR) 1.40,95% 置信区间 1.27-1.56)、VPTB(1.94,1.25-3.01)、LBW(1.63,1.30-2.04)、SGA(1.53,1.17-1.99)和 VSGA(1.48,1.16-1.87)的风险更高。接受以 PI 为基础的抗逆转录病毒疗法(主要是洛匹那韦/利托那韦或未指定)的 WLHIV 感染 PTB(1.88,1.55-2.28)、VPTB(2.06,1.01-4.18)、sPTB(16.96,1.01-284.08)、LBW(2.90,2.41-3.50)、VLBW(4.35,2.67-7.09)和 VSGA(2.37,1.84-3.05)。与 HIV 阴性妇女相比,接受 INSTI 抗逆转录病毒疗法(主要是多罗替韦)的 WLHIV 患 PTB(1.17,1.06-1.30)和 SGA(1.20,1.08-1.33)的风险更高:结论:与 HIV 阴性妇女相比,接受抗逆转录病毒疗法的 WLHIV 妇女围产期不良结局的风险更高,无论抗逆转录病毒疗法药物的类别如何。这强调了进一步优化妊娠期抗逆转录病毒疗法并改善 WLHIV 围产期结局的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
AIDS
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.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信