Safety of Tenofovir Disoproxil Fumarate-Based Antiretroviral Therapy Regimens in Pregnancy for HIV-Infected Women and Their Infants: A Systematic Review and Meta-Analysis

被引：0

作者：

Nachega, Jean B. ^{[1
,2
,3
,4
,5
]}

Uthman, Olalekan A. ^{[6
,7
,8
]}

Mofenson, Lynne M. ^{[9
]}

Anderson, Jean R. ^{[10
]}

Kanters, Steve ^{[11
,12
]}

Renaud, Francoise ^{[13
]}

Ford, Nathan ^{[13
]}

Essajee, Shaffiq ^{[13
]}

Doherty, Meg C. ^{[13
]}

Mills, Edward J. ^{[12
]}

机构：

[1] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA

[2] Univ Pittsburgh, Dept Microbiol & Infect Dis, Pittsburgh, PA USA

[3] Stellenbosch Univ, Dept Med, Ctr Infect Dis, Cape Town, South Africa

[4] Johns Hopkins Univ, Dept Epidemiol, Baltimore, MD USA

[5] Johns Hopkins Univ, Dept Int Hlth, Baltimore, MD USA

[6] Univ Warwick, Ctr Appl Hlth Res & Delivery, Warwick Med Sch, Coventry, W Midlands, England

[7] Karolinska Inst, Dept Publ Hlth IHCAR, Stockholm, Sweden

[8] Stellenbosch Univ, Dept Global Hlth, Ctr Evidence Based Hlth Care, Tygerberg, South Africa

[9] Elizabeth Glazer Pediat AIDS Fdn, Washington, DC USA

[10] Johns Hopkins Sch Med, Dept Obstet & Ginecol, Baltimore, MD USA

[11] Univ British Columbia, Dept Stat, Vancouver, BC, Canada

[12] Global Evaluat Sci, Vancouver, BC, Canada

[13] WHO, Dept HIV, Geneva, Switzerland

来源：

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES | 2017年 / 76卷 / 01期

基金：

美国国家卫生研究院;

关键词：

pregnancy; HIV; tenofovir; toxicity; BONE-MINERAL DENSITY; IN-UTERO EXPOSURE; OPTION B PLUS; CONGENITAL-ANOMALIES; ABACAVIR-LAMIVUDINE; UNINFECTED CHILDREN; GROWTH OUTCOMES; PHARMACOKINETICS; EMTRICITABINE; LOPINAVIR/RITONAVIR;

D O I：

暂无

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: There are limited data on adverse effects of tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) on pregnant women and their infants. Methods: We conducted a systematic review of studies published between January 1980 and January 2017 that compared adverse outcomes in HIV-infected women receiving TDF-vs. non-TDF-based ART during pregnancy. The risk ratio (RR) for associations was pooled using a fixed-effects model. Results: Seventeen studies met the study inclusion criteria. We found that the rate of preterm (< 37 weeks gestation) delivery (RR = 0.90, 95% confidence interval [CI]: 0.81 to 0.99, I-2 = 59%) and stillbirth (RR = 0.60, 95% CI: 0.43 to 0.84, I-2 = 72.0%) were significantly lower in women exposed (vs. not) to TDF-based ART regimen. We found no increased risk in maternal severe (grade 3) or potentially life-threatening (grade 4) adverse events (RR = 0.62; 95% CI: 0.30 to 1.29), miscarriage (RR = 1.09; 95% CI: 0.80 to 1.48), very preterm (< 34 weeks gestation) delivery (RR = 1.08, 95% CI: 0.72 to 1.62), small for gestational age (RR = 0.87, 95% CI: 0.67 to 1.13), low birth weight (RR = 0.91; 95% CI: 0.80 to 1.04), very low birth weight (RR = 3.18; 95% CI: 0.65 to 15.63), congenital anomalies (RR = 1.03; 95% CI: 0.83 to 1.28), infant adverse outcomes or infant mortality (age > 14 days) (RR = 0.65; 95% CI: 0.23 to 1.85), but increased neonatal mortality (age < 14 days) risk (RR = 5.64, 95% CI: 1.70 to 18.79) with TDR-based ART exposure. No differences were found for anthropomorphic parameters at birth; one study reported minor differences in z-scores for length and head circumference at age 1 year. Conclusions: TDF-based ART in pregnancy seems generally safe for women and their infants. However, data remain limited and further studies are needed, particularly to assess neonatal mortality and infant growth/bone effects.

引用

页码：1 / 12

页数：12

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