Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada.
Int J Gynaecol Obstet. 2023 Aug;162(2):614-622. doi: 10.1002/ijgo.14705. Epub 2023 Feb 20.
To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small-for-gestational age (SGA) birth among pregnant women and people living with HIV in Canada.
Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth (<10th percentile) was explored using mixed effects logistic regression and time-dependent Cox proportional hazards models.
Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor-(adjusted hazard ratio [aHR], 1.73; P = 0.019) and boosted protease inhibitor- (aHR, 186; P = 0.007) based regimens compared with integrase strand transfer inhibitor (INSTI)-based regimens. ART initiation prior to conception was associated with a lower risk of SGA birth compared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P = 0.024) and > 14 weeks (aOR, 0.70; P = 0.005).
INSTI-based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGA birth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV.
评估抗逆转录病毒疗法（ART）的类型和时机对加拿大 HIV 感染者孕妇早产（PTD）和小于胎龄儿（SGA）出生风险的影响。
本回顾性队列研究的数据来自 1990 年至 2020 年加拿大围产期 HIV 监测计划。采用混合效应逻辑回归和时间依赖性 Cox 比例风险模型探讨 ART 与 PTD（<37 周）和 SGA 出生（<第 10 百分位数）风险的关系。
共有 14.9%（4379 例中的 654 例）发生 PTD，18.5%（3947 例中的 732 例）发生 SGA。与基于整合酶抑制剂的方案相比，非核苷类逆转录酶抑制剂（校正后危险比[aHR]，1.73；P=0.019）和增效蛋白酶抑制剂（aHR，186；P=0.007）的方案 PTD 风险更高。与受孕后 1 至 14 周（校正后比值比[aOR]，0.69；P=0.024）和>14 周（aOR，0.70；P=0.005）时开始 ART 相比，受孕前开始 ART 与 SGA 出生风险较低相关。这些发现与总体安全性数据一起，在为 HIV 感染者提供妊娠咨询时应加以考虑。
