National Perinatal Epidemiology Unit, Nuffield Department of Population Health.
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
AIDS. 2022 Aug 1;36(10):1409-1427. doi: 10.1097/QAD.0000000000003248. Epub 2022 May 25.
Assess adverse perinatal outcomes in pregnant women living with HIV (WLHIV) receiving HAART or zidovudine (ZDV) monotherapy, compared with antiretroviral therapy (ART)-naive WLHIV and HIV-negative women.
Systematic review and meta-analysis.
We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published between 1 January 1980 and 20 April 2020. We included studies reporting on the association of pregnant WLHIV receiving HAART or ZDV monotherapy with 11 perinatal outcomes: preterm birth (PTB), very PTB, spontaneous PTB (sPTB), low birth weight (LBW), very LBW, term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted.
Sixty-one cohort studies assessing 409 781 pregnant women were included. WLHIV receiving ZDV monotherapy were associated with a decreased risk of PTB [relative risk 0.70, 95% confidence interval (CI) 0.62-0.79] and LBW (0.77, 0.67-0.88), and comparable risk of SGA, compared with ART-naive WLHIV. WLHIV receiving ZDV monotherapy had a comparable risk of PTB and LBW, and an increased risk of SGA (1.16, 1.04-1.30) compared with HIV-negative women. In contrast, WLHIV receiving HAART were associated with a comparable risk of PTB and LBW, and increased risk of SGA (1.38, 1.09-1.75), compared with ART-naive WLHIV. WLHIV receiving HAART were associated with an increased risk of PTB (1.55, 1.38-1.74), sPTB (2.09, 1.48-2.96), LBW (1.79, 1.51-2.13), term LBW (1.88, 1.23-2.85), SGA (1.80,1.34-2.40), and VSGA (1.22, 1.10-1.34) compared with HIV-negative women.
Pregnant WLHIV receiving HAART have an increased risk of a wide range of perinatal outcomes compared with HIV-negative women.
评估接受高效抗逆转录病毒治疗（HAART）或齐多夫定（ZDV）单药治疗与抗逆转录病毒治疗（ART）初治 HIV 阳性（WLHIV）和 HIV 阴性女性相比，HIV 阳性孕妇的不良围产期结局。
系统评价和荟萃分析。
我们通过搜索 PubMed、CINAHL、全球健康和 EMBASE，对 1980 年 1 月 1 日至 2020 年 4 月 20 日期间发表的研究进行了系统文献回顾。我们纳入了报告 HIV 阳性孕妇接受 HAART 或 ZDV 单药治疗与 11 种围产期结局（早产、极早产、自发性早产、低出生体重、极低出生体重、足月低出生体重、早产低出生体重、小于胎龄儿、极小于胎龄儿、死胎和新生儿死亡）相关性的研究。进行了随机效应荟萃分析。
共纳入了 61 项评估了 409781 名孕妇的队列研究。与 ART 初治 WLHIV 相比，接受 ZDV 单药治疗的 WLHIV 发生早产[相对风险 0.70，95%置信区间（CI）0.62-0.79]和低出生体重（0.77，0.67-0.88）的风险降低，而小于胎龄儿的风险无差异。与 HIV 阴性女性相比，接受 ZDV 单药治疗的 WLHIV 发生早产和低出生体重的风险无差异，但发生小于胎龄儿的风险增加（1.16，1.04-1.30）。相比之下，接受 HAART 治疗的 WLHIV 发生早产和低出生体重的风险无差异，但发生小于胎龄儿的风险增加（1.38，1.09-1.75）。与 HIV 阴性女性相比，接受 HAART 治疗的 WLHIV 发生早产的风险增加（1.55，1.38-1.74）、自发性早产的风险增加（2.09，1.48-2.96）、低出生体重的风险增加（1.79，1.51-2.13）、足月低出生体重的风险增加（1.88，1.23-2.85）、小于胎龄儿的风险增加（1.80，1.34-2.40）和极小于胎龄儿的风险增加（1.22，1.10-1.34）。
与 HIV 阴性女性相比，接受 HAART 治疗的 HIV 阳性孕妇发生一系列围产期不良结局的风险增加。
