Kourtis Athena P, Schmid Christopher H, Jamieson Denise J, Lau Joseph
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
AIDS. 2007 Mar 12;21(5):607-15. doi: 10.1097/QAD.0b013e32802ef2f6.
The use of antiretroviral agents in pregnant HIV-infected women has been reported to increase the risk of premature delivery in some studies. We performed a meta-analysis on relevant studies to address this question.
We searched Medline, Embase and the Cochrane Controlled Clinical Trials Register for English language articles. Studies that reported premature delivery for HIV-infected women treated with antiretroviral regimens during pregnancy were selected. Meta-analyses were performed using a random effects model.
Thirteen prospective cohorts and one retrospective study met the inclusion criteria. Antiretroviral therapy during pregnancy did not increase the risk of premature delivery overall [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.76-1.34]. In subgroup analyses, compared with no therapy, monotherapy (mostly zidovudine) conferred an OR of 0.86 (95% CI 0.73-1.01), whereas combination therapy conferred an OR of 1.13 (95% CI 0.79-1.63). The use of protease inhibitor (PI)-containing combinations resulted in an OR for premature delivery of 1.24 (95% CI 0.76-2.02), compared with combinations without PI. The initiation of combination therapy before pregnancy or in the first trimester resulted in an OR of 1.71 (95% CI 1.09-2.67) compared with therapy initiation in the second trimester and beyond. There was a large degree of heterogeneity between studies.
Evidence indicates that antiretroviral therapy during pregnancy is not associated with an overall increased risk of premature delivery. The use of combination regimens before or early in pregnancy may slightly increase the risk of prematurity. Continued surveillance will be necessary to quantify such a risk accurately.
在一些研究中，已报道感染HIV的孕妇使用抗逆转录病毒药物会增加早产风险。我们针对这一问题对相关研究进行了荟萃分析。
我们在Medline、Embase和Cochrane对照临床试验注册库中检索英文文章。选择那些报告了孕期接受抗逆转录病毒治疗方案的感染HIV的妇女发生早产情况的研究。采用随机效应模型进行荟萃分析。
13项前瞻性队列研究和1项回顾性研究符合纳入标准。孕期抗逆转录病毒治疗总体上并未增加早产风险[比值比（OR）为1.01，95%置信区间（CI）为0.76 - 1.34]。在亚组分析中，与未治疗相比，单药治疗（大多为齐多夫定）的OR为0.86（95% CI为0.73 - 1.01），而联合治疗的OR为1.13（95% CI为0.79 - 1.63）。与不含蛋白酶抑制剂（PI）的联合治疗相比，含PI的联合治疗导致早产的OR为1.24（95% CI为0.76 - 2.02）。与在孕中期及以后开始治疗相比，在怀孕前或孕早期开始联合治疗的OR为1.71（95% CI为1.09 - 2.67）。研究之间存在很大程度的异质性。
有证据表明孕期抗逆转录病毒治疗与早产风险总体增加无关。在怀孕前或孕早期使用联合治疗方案可能会略微增加早产风险。需要持续监测以准确量化此类风险。
