{"title":"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","authors":"Pippa Boering, Claudia Murray, Clara Portwood, Molly Hey, Lucy Thompson, Katharina Beck, Imogen Cowdell, Harriet Sexton, Mary Kumarendran, Zoe Brandon, Shona Kirtley, Joris Hemelaar","doi":"10.1097/QAD.0000000000004104","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Increasingly, pregnant women living with HIV (WLHIV) initiate antiretroviral therapy (ART) before conception. We assessed the risk of adverse perinatal outcomes among pregnant WLHIV initiating ART preconception or antenatally, compared with women without HIV or ART-naïve WLHIV.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, CINAHL, and Global Health for studies published between 1/1/1980 and 14/7/2023. 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.</p><p><strong>Results: </strong>Thirty-one cohort studies were eligible, including 199,156 women in 19 countries. WLHIV with preconception ART were associated with increased risk of PTB (risk ratio 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), and VSGA (2.79, 1.04-7.47), compared with women without HIV. WLHIV with antenatal ART were associated with increased risk of 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), and VSGA (1.21, 1.09-1.33), compared with women without HIV. Compared to ART-naïve WLHIV, WLHIV with preconception or antenatal ART were associated with increased risk of SGA (preconception: 1.40, 1.12-1.73; antenatal: 1.39, 1.11-1.74) and VSGA (preconception: 2.44, 1.63-3.66; antenatal: 2.24, 1.48-3.40).</p><p><strong>Conclusion: </strong>Among WLHIV, both preconception and antenatal initiation of ART are associated with increased risks of adverse perinatal outcomes, compared to women without HIV and ART-naïve WLHIV.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Perinatal outcomes among pregnant women living with HIV initiating antiretroviral therapy preconception and antenatally: systematic review and meta-analysis.\",\"authors\":\"Pippa Boering, Claudia Murray, Clara Portwood, Molly Hey, Lucy Thompson, Katharina Beck, Imogen Cowdell, Harriet Sexton, Mary Kumarendran, Zoe Brandon, Shona Kirtley, Joris Hemelaar\",\"doi\":\"10.1097/QAD.0000000000004104\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Increasingly, pregnant women living with HIV (WLHIV) initiate antiretroviral therapy (ART) before conception. We assessed the risk of adverse perinatal outcomes among pregnant WLHIV initiating ART preconception or antenatally, compared with women without HIV or ART-naïve WLHIV.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, EMBASE, CINAHL, and Global Health for studies published between 1/1/1980 and 14/7/2023. 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.</p><p><strong>Results: </strong>Thirty-one cohort studies were eligible, including 199,156 women in 19 countries. WLHIV with preconception ART were associated with increased risk of PTB (risk ratio 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), and VSGA (2.79, 1.04-7.47), compared with women without HIV. WLHIV with antenatal ART were associated with increased risk of 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), and VSGA (1.21, 1.09-1.33), compared with women without HIV. Compared to ART-naïve WLHIV, WLHIV with preconception or antenatal ART were associated with increased risk of SGA (preconception: 1.40, 1.12-1.73; antenatal: 1.39, 1.11-1.74) and VSGA (preconception: 2.44, 1.63-3.66; antenatal: 2.24, 1.48-3.40).</p><p><strong>Conclusion: </strong>Among WLHIV, both preconception and antenatal initiation of ART are associated with increased risks of adverse perinatal outcomes, compared to women without HIV and ART-naïve WLHIV.</p>\",\"PeriodicalId\":7502,\"journal\":{\"name\":\"AIDS\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-01-03\",\"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.0000000000004104\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIDS","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAD.0000000000004104","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Perinatal outcomes among pregnant women living with HIV initiating antiretroviral therapy preconception and antenatally: systematic review and meta-analysis.
Objective: Increasingly, pregnant women living with HIV (WLHIV) initiate antiretroviral therapy (ART) before conception. We assessed the risk of adverse perinatal outcomes among pregnant WLHIV initiating ART preconception or antenatally, compared with women without HIV or ART-naïve WLHIV.
Design: Systematic review and meta-analysis.
Methods: We searched PubMed, EMBASE, CINAHL, and Global Health for studies published between 1/1/1980 and 14/7/2023. 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. WLHIV with preconception ART were associated with increased risk of PTB (risk ratio 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), and VSGA (2.79, 1.04-7.47), compared with women without HIV. WLHIV with antenatal ART were associated with increased risk of 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), and VSGA (1.21, 1.09-1.33), compared with women without HIV. Compared to ART-naïve WLHIV, WLHIV with preconception or antenatal ART were associated with increased risk of SGA (preconception: 1.40, 1.12-1.73; antenatal: 1.39, 1.11-1.74) and VSGA (preconception: 2.44, 1.63-3.66; antenatal: 2.24, 1.48-3.40).
Conclusion: Among WLHIV, both preconception and antenatal initiation of ART are associated with increased risks of adverse perinatal outcomes, compared to women without HIV and ART-naïve WLHIV.
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.
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