在孕前和孕期开始抗逆转录病毒治疗的感染艾滋病毒孕妇中的围产期结局。
Perinatal outcomes among pregnant women with HIV initiating antiretroviral therapy preconception and antenatally.
作者信息
Boering Pippa, Murray Claudia, Portwood Clara, Hey Molly, Thompson Lucy, Beck Katharina, Cowdell Imogen, Sexton Harriet, Kumarendran Mary, Brandon Zoe, Kirtley Shona, Hemelaar Joris
机构信息
Infectious Disease 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.
出版信息
AIDS. 2025 Apr 1;39(5):584-596. doi: 10.1097/QAD.0000000000004104. Epub 2025 Jan 9.
OBJECTIVE
Increasingly, pregnant women with HIV (WHIV) initiate antiretroviral therapy (ART) before conception. We assessed the risk of adverse perinatal outcomes among pregnant WHIV initiating ART preconception or antenatally, compared with women without HIV or ART-naive WHIV.
DESIGN
Systematic review and meta-analysis.
METHODS
We searched PubMed, EMBASE, CINAHL, and Global Health for studies published between 1 January 1980 and 14 July 2023. We assessed the association of preconception/antenatal ART initiation with preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Data were analysed using random effects meta-analyses. Quality assessments, subgroup and sensitivity analyses were conducted. PROSPERO registration: CRD42021248987.
RESULTS
Thirty-one cohort studies were eligible, including 199 156 women in 19 countries. WHIV with preconception ART were associated with increased risk of PTB [risk ratio (RR) 1.55; 95% confidence interval (CI) 1.27-1.90], VPTB (RR 2.14, 95% CI 1.02-4.47), LBW (RR 2.19, 95% CI 1.32-3.63), VLBW (RR 3.34, 95% CI 1.08-10.35), SGA (RR 1.92, 95% CI 1.01-3.66), and VSGA (RR 2.79, 95% CI 1.04-7.47), compared with women without HIV. WHIV with antenatal ART were associated with increased risk of PTB (RR 1.35, 95% CI 1.15-1.58), LBW (RR 2.16, 95% CI 1.39-3.34), VLBW (RR 1.97, 95% CI 1.01-3.84), SGA (RR 1.77, 95% CI 1.10-2.84), and VSGA (RR 1.21, 95% CI 1.09-1.33), compared with women without HIV. Compared to ART-naive WHIV, WHIV with preconception or antenatal ART were associated with increased risk of SGA (preconception: RR 1.40, 95% CI 1.12-1.73; antenatal: RR 1.39, 95% CI 1.11-1.74) and VSGA (preconception: RR 2.44, 95% CI 1.63-3.66; antenatal: RR 2.24, 95% CI 1.48-3.40).
CONCLUSION
Among WHIV, both preconception and antenatal initiation of ART are associated with increased risks of adverse perinatal outcomes, compared to women without HIV and ART-naive WHIV.
目的
越来越多感染艾滋病毒的孕妇（WHIV）在受孕前就开始接受抗逆转录病毒治疗（ART）。我们评估了与未感染艾滋病毒的女性或未接受过抗逆转录病毒治疗的感染艾滋病毒孕妇相比，在受孕前或孕期开始接受抗逆转录病毒治疗的感染艾滋病毒孕妇发生围产期不良结局的风险。
设计
系统评价和荟萃分析。
方法
我们在PubMed、EMBASE、CINAHL和全球健康数据库中检索了1980年1月1日至2023年7月14日发表的研究。我们评估了受孕前/孕期开始抗逆转录病毒治疗与早产（PTB）、极早早产（VPTB）、自发性早产（sPTB）、低出生体重（LBW）、极低出生体重（VLBW）、小于胎龄儿（SGA）、极小于胎龄儿（VSGA）、死产和新生儿死亡（NND）之间的关联。使用随机效应荟萃分析对数据进行分析。进行了质量评估、亚组分析和敏感性分析。PROSPERO注册号：CRD42021248987。
结果
31项队列研究符合条件，包括来自19个国家的199156名女性。与未感染艾滋病毒的女性相比，受孕前接受抗逆转录病毒治疗的感染艾滋病毒孕妇发生早产（风险比[RR]1.55；95%置信区间[CI]1.27-1.90）、极早早产（RR 2.14，95%CI 1.02-4.47）、低出生体重（RR 2.19，95%CI 1.32-3.63）、极低出生体重（RR 3.34，95%CI 1.08-10.35）、小于胎龄儿（RR 1.92，95%CI 1.01-3.66）和极小于胎龄儿（RR 2.79，95%CI 1.04-7.47）的风险增加。与未感染艾滋病毒的女性相比，孕期接受抗逆转录病毒治疗的感染艾滋病毒孕妇发生早产（RR 1.35，95%CI 1.15-1.58）、低出生体重（RR 2.16，95%CI 1.39-3.34）、极低出生体重（RR 1.97，95%CI 1.01-3.84）、小于胎龄儿（RR 1.77，95%CI 1.10-2.84）和极小于胎龄儿（RR 1.21，95%CI 1.09-1.33）的风险增加。与未接受过抗逆转录病毒治疗的感染艾滋病毒孕妇相比，受孕前或孕期接受抗逆转录病毒治疗的感染艾滋病毒孕妇发生小于胎龄儿（受孕前：RR 1.40，95%CI 1.12-1.73；孕期：RR 1.39，95%CI 1.11-1.74）和极小于胎龄儿（受孕前：RR 2.44，95%CI 1.63-3.66；孕期：RR 2.24，95%CI 1.48-3.40）的风险增加。
结论
与未感染艾滋病毒的女性和未接受过抗逆转录病毒治疗的感染艾滋病毒孕妇相比，感染艾滋病毒孕妇在受孕前和孕期开始接受抗逆转录病毒治疗均与围产期不良结局风险增加有关。
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