Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa.
Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa.
Viruses. 2023 Jun 26;15(7):1441. doi: 10.3390/v15071441.
Antiretroviral therapy (ART) regimens have been shown to cause metabolic changes in people living with HIV (PLWH), predisposing them to cardiometabolic disease (CVMD). However, such evidence is less established in pregnant women living with HIV (pWLWH) on ART. Pregnancy-induced cardiometabolic risks (CMR) can predispose to unfavourable pregnancy outcomes and further persist in the postpartum period, resolve, and recur in subsequent pregnancies, or emerge as newly diagnosed chronic diseases of ageing. Therefore, this systematic review aimed at synthesizing evidence on CMR and perinatal outcomes among pWLWH in the era of ART. We considered prospective and retrospective cohorts, case-control, cross-sectional, and interventional studies published in English. Specific keywords were used to conduct a thorough literature search on PubMed-Medline and Scopus following the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Two investigators independently screened the search outputs and reviewed full texts of potentially eligible articles. Data extraction was conducted by one investigator and verified by the second investigator. Thirty-one relevant studies conducted on 20,904 pWLWH on ART across Africa, Asia, Europe, and America were included. Studies demonstrate inconclusive findings, especially on perinatal outcomes, but significant risks of gestational hypertension and dyslipidemia were reported in pWLWH on ART compared to the control group. Therefore, future studies should focus more on these perinatal outcomes, and their impact on postpartum maternal health and growth trajectories of uninfected infants born from pWLWH who are either on ART or ART-naïve in comparison to infants born of HIV-negative mothers over the life course, especially in HIV-burdened African countries.
抗逆转录病毒疗法 (ART) 已被证明会引起 HIV 感染者 (PLWH) 的代谢变化，使他们易患心血管代谢疾病 (CVMD)。然而，在接受 ART 的 HIV 感染孕妇 (pWLWH) 中，这种证据还不太确定。妊娠引起的心血管代谢风险 (CMR) 可能导致不良的妊娠结局，并在产后持续存在、缓解、在随后的妊娠中再次出现，或作为新诊断的老年慢性疾病出现。因此，本系统评价旨在综合评估 ART 时代 pWLWH 的 CMR 和围产期结局的证据。我们考虑了前瞻性和回顾性队列研究、病例对照研究、横断面研究和干预性研究，这些研究均发表在英文期刊上。根据系统评价和荟萃分析报告的首选条目，使用特定的关键词在 PubMed-Medline 和 Scopus 上进行了全面的文献检索。两名调查员独立筛选检索结果，并审查了潜在合格文章的全文。由一名调查员进行数据提取，由第二名调查员进行验证。共纳入了 31 项在非洲、亚洲、欧洲和美洲进行的、涉及 20904 名接受 ART 的 pWLWH 的相关研究。这些研究的结果并不一致，特别是关于围产期结局的研究，但与对照组相比，接受 ART 的 pWLWH 发生妊娠高血压和血脂异常的风险显著增加。因此，未来的研究应更多地关注这些围产期结局，以及它们对产后母婴健康和未感染婴儿生长轨迹的影响，特别是在 HIV 负担沉重的非洲国家，与 HIV 阴性母亲所生婴儿相比。
