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Safety of tenofovir disoproxil fumarate-based antiretroviral therapy regimens in pregnancy for HIV-infected women and their infants : a systematic review and meta-analysis
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Nachega, Jean B., Uthman, Olalekan A., Mofenson, Lynne M., Anderson, Jean R., Kanters, Steve, Renaud, Francoise, Ford, Nathan, Essajee, Shaffiq, Doherty, Meg C. and Mills, Edward J. (2017) Safety of tenofovir disoproxil fumarate-based antiretroviral therapy regimens in pregnancy for HIV-infected women and their infants : a systematic review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 76 (1). pp. 1-12. doi:10.1097/QAI.0000000000001359 ISSN 1525-4135.
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Official URL: https://doi.org/10.1097/QAI.0000000000001359
Abstract
There are limited data on adverse effects of tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) on pregnant women and their infants. We conducted a systematic review of studies published between January 1980 and January 2017 that compared adverse outcomes in HIV-infected women receiving TDF- vs. non-TDF-based ART during pregnancy. The relative risk for associations was pooled using a fixed-effects model. Sixteen studies met study inclusion criteria. We found that the rate of preterm (<37 weeks gestation) delivery (RR = 0.90, 95%CI: 0.81-0.99, I= 59%) and stillbirth (RR = 0.60, 95%CI: 0.43-0.84, I = 72.0%) were significantly lower in women exposed (vs. not) TDF-based ART regimen. We found no increased risk in maternal severe (Grade 3) or potentially life-threatening (Grade 4) AEs (RR=0.62;95%CI: 0.30-1.29), miscarriage (RR=1.09; 95%CI: 0.80-1.48), very preterm (<34 weeks gestation) delivery (RR = 1.08, 95%CI: 0.72-1.62), small for gestational age (RR=0.87, 95%CI: 0.67-1.13), low birth weight (RR=0.91;95%CI: 0.80-1.04), very low birth weight (RR=3.18;95%CI: 0.65 to 15.63), congenital anomalies (RR=1.03; 95%CI: 0.83- 1.28), infant adverse outcomes or infant mortality (age >14 days) (RR=0.65; 95%CI: 0.23-1.85), but increased neonatal mortality (age <14 days) risk (RR=5.64, 95%CI: 1.70-18.79) with TDR-based ART exposure. No differences were found for anthropomorphic parameters at birth; one study reported minor differences in z-scores for length and head circumference at age one year. TDF-based ART in pregnancy appears generally safe for women and their infants. However, data remain limited and further studies are needed, particularly to assess neonatal mortality and infant growth/bone effects.
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 |
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SWORD Depositor: | Library Publications Router | ||||||
Journal or Publication Title: | Journal of Acquired Immune Deficiency Syndromes | ||||||
Publisher: | Lippincott Williams & Wilkins | ||||||
ISSN: | 1525-4135 | ||||||
Official Date: | September 2017 | ||||||
Dates: |
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Volume: | 76 | ||||||
Number: | 1 | ||||||
Page Range: | pp. 1-12 | ||||||
DOI: | 10.1097/QAI.0000000000001359 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Reuse Statement (publisher, data, author rights): | ** From PubMed via Jisc Publications Router. | ||||||
Access rights to Published version: | Open Access (Creative Commons) |
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