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Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis
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Uthman, Olalekan A., Nachega, Jean B., Anderson, Jean, Kanters, Steve, Mills, Edward J., Renaud, Françoise, Essajee, Shaffiq, Doherty, Meg C. and Mofenson, Lynne M. (2017) Timing of initiation of antiretroviral therapy and adverse pregnancy outcomes : a systematic review and meta-analysis. The Lancet HIV, 4 (1). e21-e30. doi:10.1016/S2352-3018(16)30195-3 ISSN 2352-3018.
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Official URL: https://doi.org/10.1016/S2352-3018(16)30195-3
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.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||
Journal or Publication Title: | The Lancet HIV | ||||||
Publisher: | Lancet | ||||||
ISSN: | 2352-3018 | ||||||
Official Date: | January 2017 | ||||||
Dates: |
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Volume: | 4 | ||||||
Number: | 1 | ||||||
Page Range: | e21-e30 | ||||||
DOI: | 10.1016/S2352-3018(16)30195-3 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
RIOXX Funder/Project Grant: |
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