Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
Medical Research Council/Developmental Pathways for Health Research Unit, School of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
AIDS. 2020 Sep 1;34(11):1643-1656. doi: 10.1097/QAD.0000000000002593.
Assess adverse perinatal outcomes associated with antenatal antiretroviral therapy (ART) regimens.
Systematic review and network meta-analysis of randomized controlled trials (RCTS).
We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, EMBASE, and the Cochrane Central Register of Controlled Trials and four clinical trial databases from 1 January 1980 to 28 April 2018. We included RCTs of antenatal ART regimens in HIV-positive pregnant women, which assessed preterm birth (PTB), spontaneous preterm birth (sPTB), very preterm birth (VPTB), low birthweight (LBW), very low birthweight (VLBW), small-for-gestational-age (SGA), neonatal death (NND), and mother-to-child-transmission. We used random-effects network meta-analysis models to calculate relative risks for treatment comparisons and the hierarchy of treatments.
Of 83 260 citations identified, 10 manuscripts were included, assessing 6285 women. Compared with zidovudine (ZDV) monotherapy, we found a higher risk of LBW after exposure to zidovudine/lamivudine/efavirenz (ZDV/3TC/EFV; relative risk 1.61; 95% CI 1.03-2.51), tenofovir disoproxil fumarate/emtricitabine/ritonavir-boosted lopinavir (TDF/FTC/LPV/r; 1.64; 1.18-2.29), or zidovudine/lamivudine/ritonavir-boosted lopinavir (ZDV/3TC/LPV/r; 1.87; 1.58-2.20). TDF/FTC/LPV/r carried an increased risk of VLBW, compared with ZDV monotherapy (5.40; 1.08-27.08). ZDV/3TC/LPV/r posed a higher risk of PTB than ZDV monotherapy (1.43; 1.08-1.91) and a higher risk of sPTB than zidovudine/lamivudine/abacavir (ZDV/3TC/ABC) (1.81; 1.21-2.71). LPV/r-containing regimens also carried the highest risks of VPTB, SGA and NND, although the limited data showed no significant differences.
Of the ART regimens assessed in RCTs in pregnancy, LPV/r-containing regimens were associated with the highest risks of adverse perinatal outcomes.
评估产前抗逆转录病毒疗法（ART）方案与不良围产结局的相关性。
对随机对照试验（RCT）进行系统评价和网络荟萃分析。
我们通过检索 PubMed、CINAHL、全球卫生、EMBASE 和 Cochrane 对照试验中心注册库以及 4 个临床试验数据库，从 1980 年 1 月 1 日至 2018 年 4 月 28 日，对 HIV 阳性孕妇产前 ART 方案的相关文献进行了系统综述。我们纳入了评估早产（PTB）、自发性早产（sPTB）、极早产（VPTB）、低出生体重（LBW）、极低出生体重（VLBW）、小于胎龄儿（SGA）、新生儿死亡（NND）和母婴传播的 RCT 研究。我们使用随机效应网络荟萃分析模型计算治疗比较的相对风险和治疗层次结构。
在 83260 篇引文中共纳入 10 篇文献，共评估了 6285 名女性。与齐多夫定（ZDV）单药治疗相比，我们发现暴露于齐多夫定/拉米夫定/依非韦伦（ZDV/3TC/EFV）、替诺福韦二吡呋酯/恩曲他滨/利托那韦增效洛匹那韦（TDF/FTC/LPV/r）或齐多夫定/拉米夫定/利托那韦增效洛匹那韦（ZDV/3TC/LPV/r）后，LBW 的风险更高（ZDV/3TC/EFV：相对风险 1.61；95%CI 1.03-2.51；TDF/FTC/LPV/r：1.64；1.18-2.29；ZDV/3TC/LPV/r：1.87；1.58-2.20）。与 ZDV 单药治疗相比，TDF/FTC/LPV/r 增加了极低出生体重（VLBW）的风险（5.40；1.08-27.08）。ZDV/3TC/LPV/r 与 ZDV 单药治疗相比，PTB 的风险更高（1.43；1.08-1.91），与齐多夫定/拉米夫定/阿巴卡韦（ZDV/3TC/ABC）相比，sPTB 的风险更高（1.81；1.21-2.71）。尽管数据有限，但 LPV/r 包含的方案也与 VPTB、SGA 和 NND 的最高风险相关。
在妊娠 RCT 中评估的 ART 方案中，LPV/r 包含的方案与不良围产结局的相关性最高。
