Adverse perinatal outcomes associated with antiretroviral therapy regimens: systematic review and network meta-analysis

Abstract

Objective: Assess adverse perinatal outcomes associated with antenatal antiretroviral therapy (ART) regimens.Design: Systematic review and network meta-analysis of randomised controlled trials (RCTS). Methods:We conducted a systematic literature review by searching PubMed, CINAHL,

Adverse perinatal outcomes associated with protease inhibitor-based antiretroviral therapy in pregnant women living with HIV: A systematic review and meta-analysis

“…In contrast, in the network meta-analysis of RCTs no RCTs comparing ART regimens reported data on SGA and no RCTs reported on VSGA. 16 The current data therefore represents the best available evidence regarding the association of PI-ART with both SGA and VSGA. WLHIV receiving PI-ART may benefit from increased surveillance of fetal growth, which should be assessed against international standards.…”

“…It should be borne in mind that LPV/r is the only PI that has been assessed in RCTs in pregnancy, and that LPV/r-containing regimens were ranked as having the highest risk of the perinatal outcomes assessed. 16 However, among the ART regimens assessed in RCTs, ZDV/3TC/LPV/r was associated with a significantly increased risk of spontaneous PTB compared to ZDV/3TC/ABC, but no other significant differences in perinatal outcomes between ART regimens assessed were found. LPV/r-based ART regimens were significantly associated with PTB, LBW and VLBW, compared to ZDV monotherapy.…”

“…LPV/r-based ART regimens were significantly associated with PTB, LBW and VLBW, compared to ZDV monotherapy. 16 However, ZDV monotherapy, dual therapy, and NRTI-ART, such as ZDV/3TC/ABC, are no longer recommended for use in pregnancy in international treatment guidelines. 12 , 13 , 14 , 15 Therefore, RCTs provide no evidence regarding the comparative perinatal outcomes associated with different PI-ART regimens and the available data from cohort studies presented here indicate that ATV/r-ART, LPV/r-ART, and DRV/r-ART are comparable with regard to perinatal outcomes, which should inform international treatment guidelines.…”

“…A recent network meta-analysis of seven randomised controlled trials (RCTs) compared seven distinct mono-, dual- and triple drug regimens initiated during pregnancy. 16 Among the ART (i.e. triple drug) regimens assessed, LPV/r-based ART was associated with an increased risk of spontaneous PTB compared to zidovudine/lamivudine/abacavir (ZDV/3TC/ABC; a nucleoside reverse transcriptase inhibitor [NRTI] ART regimen which is no longer recommended), 17 but no other significant differences in perinatal outcomes between the ART regimens assessed were found.…”

“…Moreover, LPV/r is the only PI analysed in RCTs conducted in pregnant WLHIV to date, precluding comparison to other PIs. 16 …”