Harmsen Marissa J, Browne Joyce L, Venter Francois, Klipstein-Grobusch Kerstin, Rijken Marcus J
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMC Infect Dis. 2017 Jul 11;17(1):489. doi: 10.1186/s12879-017-2581-8.
Observed adverse effects of antiretroviral therapy (ART) on the lipid profile could be of significance in pregnancy. This systematic review aims to summarize studies that investigated the association between HIV, ART and serum lipids during pregnancy and adverse pregnancy outcomes.
A systematic search was conducted in five electronic databases to obtain articles that measured serum lipid concentrations or the incidence of dyslipidaemia in HIV-infected pregnant women. Included articles were assessed for quality according to the Cochrane Risk of Bias Tool. The extracted data was analysed through descriptive analysis.
Of the 1264 articles screened, 17 articles were included in this review; eleven reported the incidence of dyslipidaemia, and twelve on maternal serum lipid concentrations under the influence of HIV-infection and ART. No articles reported pregnancy outcomes in relation to serum lipids. Articles were of acceptable quality, but heterogenic in methods and study design. Lipid levels in HIV-infected women increased 1.5-3 fold over the trimesters of pregnancy, and remained within the physiological reference range. The percentage of women with dyslipidaemia was variable between the studies [0-88.9%] and highest in the groups on first generation protease inhibitors and for women on ART at conception.
This systematic review observed physiologic concentrations of serum lipids for HIV-infected women receiving ART during pregnancy. Serum lipids were increased in users of first generation protease inhibitors and for those on treatment at conception. There was no information available about pregnancy outcomes. Future studies are needed which include HIV-uninfected control groups, control for potential confounders, and overcome limitations associated with included studies.
观察到抗逆转录病毒疗法（ART）对血脂状况的不良影响在妊娠期间可能具有重要意义。本系统评价旨在总结调查妊娠期间HIV、ART与血清脂质之间的关联以及不良妊娠结局的研究。
在五个电子数据库中进行系统检索，以获取测量HIV感染孕妇血清脂质浓度或血脂异常发生率的文章。根据Cochrane偏倚风险工具对纳入的文章进行质量评估。通过描述性分析对提取的数据进行分析。
在筛选的1264篇文章中，本评价纳入了17篇文章；11篇报告了血脂异常的发生率，12篇报告了在HIV感染和ART影响下的孕妇血清脂质浓度。没有文章报告与血清脂质相关的妊娠结局。文章质量可接受，但方法和研究设计存在异质性。HIV感染女性的血脂水平在妊娠各阶段升高了1.5至3倍，并保持在生理参考范围内。血脂异常女性的百分比在不同研究中有所不同[0-88.9%]，在第一代蛋白酶抑制剂组和受孕时接受ART治疗的女性中最高。
本系统评价观察到妊娠期间接受ART治疗的HIV感染女性血清脂质浓度处于生理水平。第一代蛋白酶抑制剂使用者和受孕时接受治疗者的血清脂质升高。没有关于妊娠结局的信息。未来需要开展包括未感染HIV的对照组、控制潜在混杂因素并克服纳入研究相关局限性的研究。
