Magdalene K Walters,Michelle A Bulterys,Michael Barry,Sarah Hicks,Ann Richey,Margalit Sabin,Diana Louden,Mary Mahy,John Stover,Robert Glaubius,Hmwe H Kyu,Marie-Claude Boily,Lynne Mofenson,Kathleen Powis,Jeffrey W Imai-Eaton
{"title":"Probability of vertical HIV transmission: a systematic review and meta-regression.","authors":"Magdalene K Walters,Michelle A Bulterys,Michael Barry,Sarah Hicks,Ann Richey,Margalit Sabin,Diana Louden,Mary Mahy,John Stover,Robert Glaubius,Hmwe H Kyu,Marie-Claude Boily,Lynne Mofenson,Kathleen Powis,Jeffrey W Imai-Eaton","doi":"10.1016/s2352-3018(25)00132-8","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nEliminating HIV vertical transmission is a global priority and monitored by estimating paediatric HIV infections with the UNAIDS-supported Spectrum AIDS Impact Module (Spectrum-AIM). Recent innovations in antiretroviral therapy (ART) service-delivery models and first-line regimens aimed to reduce vertical transmission probabilities. We did a systematic review and meta-analysis to estimate vertical transmission probabilities by maternal immunological and treatment status.\r\n\r\nMETHODS\r\nIn this systematic review and meta-regression, we combined an updated systematic review with previous data in meta-regression models to estimate vertical transmission probabilities and determinants. We searched PubMed, Embase, the Global Health Database, WHO Global Index Medicus, CINAHL Complete, and Cochrane CENTRAL for peer-reviewed English-language studies from all regions published between Jan 1, 2018 and Feb 8, 2024, with search term domains mentioning \"HIV\", \"transmission\", \"perinatal\", and \"breastfeeding periods\", and \"infants born to women living with HIV\" or related terms from randomised trials, cohort studies, or observational studies. Four meta-regression models estimated vertical transmission probabilities. We assessed model sensitivity and compared estimates to Spectrum-AIM's previous results. Finally, we fit a meta-regression model to assess the association of ART class and initiation timing on viral load suppression (VLS) at delivery.\r\n\r\nFINDINGS\r\nOf 12 588 potential studies, we identified 24 new studies, which along with the 86 from previous reviews yielded 110 total studies included in meta-regression analysis. For women not receiving ART, higher CD4 count was associated with lower odds of perinatal vertical transmission (odds ratio [OR] 0·80, 95% CI 0·75-0·84, per 100 cells per μL increase). For pregnant women on ART, each additional week on ART before delivery reduced odds of vertical transmission by 5·6% (95% CI 4·2-7·0). The OR of perinatal vertical transmission among pregnant women initiating integrase inhibitor-based ART 20 weeks before delivery was 0·36 (0·14-0·94) compared with those initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART. This association was confounded by study region. Odds of VLS were lower when ART was initiated late in pregnancy (OR 0·37, 0·21-0·68) for the reference regimen [NNRTI]), without significant difference by ART regimen.\r\n\r\nINTERPRETATION\r\nVertical transmission probability varies by maternal immunological stage, treatment regimen, and timing of treatment initiation. These estimates have been incorporated into Spectrum-AIM for UNAIDS 2025 HIV estimates. Earlier ART initiation is associated with higher odds of VLS at delivery. Further evidence is needed on the effects of recent ART innovations on vertical transmission outcomes.\r\n\r\nFUNDING\r\nNational Institutes of Health, UNAIDS, and UK Research and Innovation.","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":"5 1","pages":""},"PeriodicalIF":13.0000,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Hiv","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/s2352-3018(25)00132-8","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND
Eliminating HIV vertical transmission is a global priority and monitored by estimating paediatric HIV infections with the UNAIDS-supported Spectrum AIDS Impact Module (Spectrum-AIM). Recent innovations in antiretroviral therapy (ART) service-delivery models and first-line regimens aimed to reduce vertical transmission probabilities. We did a systematic review and meta-analysis to estimate vertical transmission probabilities by maternal immunological and treatment status.
METHODS
In this systematic review and meta-regression, we combined an updated systematic review with previous data in meta-regression models to estimate vertical transmission probabilities and determinants. We searched PubMed, Embase, the Global Health Database, WHO Global Index Medicus, CINAHL Complete, and Cochrane CENTRAL for peer-reviewed English-language studies from all regions published between Jan 1, 2018 and Feb 8, 2024, with search term domains mentioning "HIV", "transmission", "perinatal", and "breastfeeding periods", and "infants born to women living with HIV" or related terms from randomised trials, cohort studies, or observational studies. Four meta-regression models estimated vertical transmission probabilities. We assessed model sensitivity and compared estimates to Spectrum-AIM's previous results. Finally, we fit a meta-regression model to assess the association of ART class and initiation timing on viral load suppression (VLS) at delivery.
FINDINGS
Of 12 588 potential studies, we identified 24 new studies, which along with the 86 from previous reviews yielded 110 total studies included in meta-regression analysis. For women not receiving ART, higher CD4 count was associated with lower odds of perinatal vertical transmission (odds ratio [OR] 0·80, 95% CI 0·75-0·84, per 100 cells per μL increase). For pregnant women on ART, each additional week on ART before delivery reduced odds of vertical transmission by 5·6% (95% CI 4·2-7·0). The OR of perinatal vertical transmission among pregnant women initiating integrase inhibitor-based ART 20 weeks before delivery was 0·36 (0·14-0·94) compared with those initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART. This association was confounded by study region. Odds of VLS were lower when ART was initiated late in pregnancy (OR 0·37, 0·21-0·68) for the reference regimen [NNRTI]), without significant difference by ART regimen.
INTERPRETATION
Vertical transmission probability varies by maternal immunological stage, treatment regimen, and timing of treatment initiation. These estimates have been incorporated into Spectrum-AIM for UNAIDS 2025 HIV estimates. Earlier ART initiation is associated with higher odds of VLS at delivery. Further evidence is needed on the effects of recent ART innovations on vertical transmission outcomes.
FUNDING
National Institutes of Health, UNAIDS, and UK Research and Innovation.
期刊介绍:
The Lancet HIV is an internationally trusted source of clinical, public health, and global health knowledge with an Impact Factor of 16.1. It is dedicated to publishing original research, evidence-based reviews, and insightful features that advocate for change in or illuminates HIV clinical practice. The journal aims to provide a holistic view of the pandemic, covering clinical, epidemiological, and operational disciplines. It publishes content on innovative treatments and the biological research behind them, novel methods of service delivery, and new approaches to confronting HIV/AIDS worldwide. The Lancet HIV publishes various types of content including articles, reviews, comments, correspondences, and viewpoints. It also publishes series that aim to shape and drive positive change in clinical practice and health policy in areas of need in HIV. The journal is indexed by several abstracting and indexing services, including Crossref, Embase, Essential Science Indicators, MEDLINE, PubMed, SCIE and Scopus.