Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes: a systematic review and meta-analysis.

Abstract:

BACKGROUND:Although lifelong combination antiretroviral therapy (ART) is recommended for all individuals with HIV, few data exist for pregnancy outcomes associated with ART initiation before conception. We assessed adverse pregnancy outcomes associated with ART initiated before conception compared with that of ART started after conception. METHODS:We did a systematic review of studies from low-income, middle-income, and high-income countries by searching the Cochrane Central Register of Controlled Trials, Embase, LILACS, MEDLINE, Toxline, Web of Knowledge, and WHO Global Index Medicus and trials in progress (International Clinical Trials Registry Platform) for randomised trials, quasi-randomised trials, and prospective cohort studies done between Jan 1, 1980, and June 1, 2016, in which timing of ART initiation in pregnant women living with HIV was reported. We used the risk ratio (RR) and corresponding 95% CIs as the primary measure to assess the association between the selected outcomes and ART initiation before conception versus after conception. We used a random-effects model to pool risk ratios. FINDINGS:We included 11 studies with 19 189 mother-infant pairs. Women who started ART before conception were significantly more likely to deliver preterm (pooled RR 1·20, 95% CI 1·01-1·44) or very preterm (1·53, 1·22-1·92), or to have low-birthweight infants (1·30, 1·04-1·62) than were those who began ART after conception. Few data exist for neonatal mortality. The risk of very low birthweight, small for gestational age, severe small for gestational age, stillbirth, and congenital anomalies did not differ significantly between women who were taking ART before conception and those who began ART after conception. INTERPRETATION:The benefits of ART for maternal health and prevention of perinatal transmission outweigh risks, but data for the extent and severity of these risks are scarce and of low quality. As use of ART before conception rapidly increases globally, monitoring for potential adverse pregnancy outcomes will be crucial. FUNDING:WHO.

journal_name

Lancet HIV

journal_title

The lancet. HIV

authors

Uthman OA,Nachega JB,Anderson J,Kanters S,Mills EJ,Renaud F,Essajee S,Doherty MC,Mofenson LM

doi

10.1016/S2352-3018(16)30195-3

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

e21-e30

issue

1

eissn

2405-4704

issn

2352-3018

pii

S2352-3018(16)30195-3

journal_volume

4

pub_type

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  • Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study.

    abstract:BACKGROUND:As HIV incidence and mortality continue to increase in eastern Europe and central Asia, particularly among people who inject drugs (PWID), it is crucial to effectively scale-up opioid agonist therapy (OAT), such as methadone or buprenorphine maintenance therapy, to optimise HIV outcomes. With low OAT coverag...

    journal_title:The lancet. HIV

    pub_type: 杂志文章

    doi:10.1016/S2352-3018(19)30373-X

    authors: Tan J,Altice FL,Madden LM,Zelenev A

    更新日期:2020-02-01 00:00:00