Antiretroviral therapy for pregnant women living with HIV or hepatitis B: a systematic review and meta-analysis
| Autor: | Jinell Mah Ming, Yaping Chang, Yung Lee, Arnav Agarwal, Farid Foroutan, Elliot Hepworth, Reed A C Siemieniuk, Yuan Zhang, Dena Zeraatkar, Paul E. Alexander, Arnaud Merglen, Reza Mirza, Hassan Mir, Olufunmilayo A. Lesi, Gordon H. Guyatt |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Infectious Disease Transmission
HIV Infections Zidovudine/adverse effects/therapeutic use Lopinavir 0302 clinical medicine Lopinavir/adverse effects/therapeutic use immune system diseases Pregnancy Emtricitabine Vertical 030212 general & internal medicine Pregnancy Complications Infectious network meta-analysis Ritonavir/adverse effects/therapeutic use ddc:618 Pregnancy Outcome virus diseases Lamivudine General Medicine Hepatitis B Drug Combinations Anti-Retroviral Agents HIV/AIDS Female 030211 gastroenterology & hepatology Zidovudine Tenofovir/adverse effects/therapeutic use HIV Infections/complications/drug therapy medicine.drug Adult medicine.medical_specialty Emtricitabine/adverse effects/therapeutic use HIV & AIDS Young Adult 03 medical and health sciences Hepatitis B/complications/drug therapy Acquired immunodeficiency syndrome (AIDS) Internal medicine medicine Humans chronic hepatitis B Tenofovir Adverse effect Lamivudine/adverse effects/therapeutic use Infectious/drug therapy Ritonavir business.industry Research mother-to-child transmission Infant Anti-Retroviral Agents/adverse effects/therapeutic use medicine.disease Infectious Disease Transmission Vertical digestive system diseases Surgery Pregnancy Complications business |
| Zdroj: | BMJ Open, Vol. 7, No 9 (2017) P. e019022 BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2017-019022 |
| Popis: | ObjectiveTo assess the impact of various antiretroviral/antiviral regimens in pregnant women living with HIV or hepatitis B virus (HBV).DesignWe performed random effects meta-analysis for HIV-related outcomes and network meta-analysis for HBV outcomes, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess quality separately for each outcome.Data sourcesEmbase and Medline to February 2017.Eligibility criteriaFor maternal outcomes, we considered randomised controlled trials (RCTs) comparing tenofovir-based regimens with those with alternative nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). For child outcomes, we included RCTs and comparative observational studies of tenofovir-based regimens versus alternative NRTIs regimens or, for HBV, placebo.ResultsTen studies (seven RCTs) met the inclusion criteria for maternal and child outcomes, and an additional 33 studies (12 RCTs) met the inclusion criteria for HBV-specific outcomes. The most common comparison was tenofovir and emtricitabine versus zidovudine and lamivudine. There was no apparent difference between tenofovir-based regimens and alternatives in maternal outcomes, including serious laboratory adverse events (low certainty) and serious clinical adverse events (moderate certainty). There was no difference between NRTIs in vertical transmission of HIV: 1 more per 1000, 8 fewer to 10 more, low certainty; or vertical transmission of HBV: 7 fewer per 1000, 10 fewer to 38 more, moderate certainty. We found moderate certainty evidence that tenofovir/emtricitabine increases the risk of stillbirths and early neonatal mortality (51 more per 1000, 11 more to 150 more) and the risk of early premature delivery at ConclusionsTenofovir/emtricitabine is likely to increase stillbirth/early neonatal death and early premature delivery compared with zidovudine/lamivudine, but certainty is low when they are not coprescribed with lopinavir/ritonavir. Other outcomes are likely similar between antiretrovirals.PROSPERO registration numberCRD42017054392. |
| Databáze: | OpenAIRE |
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