Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study

Tiam, Appolinaire; Kassaye, Seble; Machekano, Rhoderick; Tukei, Vincent; Gill, Michelle M.; Mokone, Majoalane; Letsie, Mosilinyane; Mots'oane, Tsietso; Seipati, Irene; Barasa, Janety; Isavwa, Anthony; Tylleskär, Thorkild; Guay, Laura

doi:10.1371/journal.pone.0226339

Cited by 6 publications

(3 citation statements)

References 22 publications

(25 reference statements)

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“…31,33,38,39 The assessment of gestational age was specified in only nine of the 27 studies. 24,34,36,[39][40][41][42][43][44] In eight studies it was based on the last menstrual period and corrected if needed by the first trimester ultrasound scan and in one study it was based on the ultrasound measurement obtained between 10 and 13+6 weeks. 39…”

Section: Outcome Definitionsmentioning

confidence: 99%

Perinatal outcomes in women living with HIV‐1 and receiving antiretroviral therapy—a systematic review and meta‐analysis

Shinar

Agrawal

Ryu

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Antiretroviral therapy‐naïve pregnant women living with HIV are at an increased risk for adverse pregnancy outcomes. It remains controversial whether this risk persists with antiretroviral therapy. We conducted a systematic review and meta‐analysis to evaluate whether pregnant women living with HIV and receiving antiretroviral therapy antenatally, are at an increased risk of adverse outcomes compared with HIV‐negative controls. Material and methods We searched MEDLINE, Embase, International Pharmaceutical Abstracts, EBM Reviews, PubMed (non‐MEDLINE records), EBSCO CINAHL Complete, Clarivate Web of Science, African Index Medicus, LILACS and Google Scholar for all observational studies comparing pregnant women living with HIV on antiretroviral therapy with HIV‐negative controls from 1 January 1994 to 10 August 2021 with no language or geographic restrictions. Perinatal outcomes included preterm birth (PTB), low birthweight, small‐for‐gestational age and preeclampsia. Using a random‐effects model we pooled raw data to generate odds ratio (OR) with 95% confidence intervals (CI) for each outcome. Sub‐analyses for high and low resource countries and time of antiretroviral therapy initiation were performed. This systematic review and meta‐analysis is registered with PROSPERO, number CRD42020182722. Results Of the 7900 citations identified, 27 were eligible for analysis (12 636 pregnant women living with HIV on antiretroviral therapy and 7 812 115 HIV‐negative controls). ORs (95% CI) of PTB (1.88 [1.63–2.17]), small‐for‐gestational age (1.60 [1.18–2.17]) and low birthweight (2.15 [1.58–2.92]) were significantly higher in pregnant women living with HIV than in HIV‐negative women, while the risk of preeclampsia (0.86 [0.57–1.30]) was comparable. The risk of PTB and low birthweight was higher in both high resource and low resource countries, while the risk of small‐for‐gestational age was higher only in the former. Preconceptional antiretroviral therapy was associated with a higher risk of PTB compared with antenatal initiation. Conclusions Pregnant women living with HIV on antiretroviral therapy have an increased risk of PTB, low birthweight and small‐for‐gestational age in high resource countries, as well as PTB and low birthweight in low income countries compared with HIV‐negative controls.

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Section: Outcome Definitionsmentioning

confidence: 99%

Perinatal outcomes in women living with HIV‐1 and receiving antiretroviral therapy—a systematic review and meta‐analysis

Shinar

Agrawal

Ryu

et al. 2021

Acta Obstet Gynecol Scand

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“…In our study, lack of, or unknown receipt of maternal ART, which also served as infant MTCT prophylaxis, was associated with HIV-positive final outcome status among HEI. This is a well-documented phenomenon among both final outcome [ 19 , 22 ] and early MTCT studies [ 21 , 30 ]. Prior studies have established that lack of; or inadequate HIV treatment or prophylaxis results in a higher maternal viral load during pregnancy, delivery or breastfeeding [ 31 – 33 ].…”

Section: Discussionmentioning

confidence: 95%

Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria

et al. 2022

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Introduction While antiretroviral therapy (ART) coverage for pregnant women has undergone steady scale-up, Nigeria’s final mother- to-child transmission of HIV (MTCT) rate remains unacceptably high at 10%. This study aimed to determine final outcomes (MTCT rates) and their correlates among HIV-exposed infants (HEI) in nine states and the Federal Capital Territory, Nigeria. Methods This retrospective, cross-sectional study was conducted at 96 primary, secondary and tertiary health facilities supported by the Institute of Human Virology Nigeria. Data was abstracted for a birth cohort of HEI born between October 30, 2014 and April 30, 2015 whose 18–24 month final outcome was assessed by October 30, 2016. Only infants with a six-week first DNA PCR result, and a rapid HIV antibody test result at age 18 to 24 months were included. Multivariate logistic regression (adjusted odds ratios [aORs]) evaluated for predictors of HIV positivity at ≥18 months. Results After testing at ≥18 months, 68 (2.8%) of the 2,405 exposed infants in the birth cohort were HIV-positive. After a minimum of 18 months of follow-up, 51 (75%) HIV-positive infants were alive on ART; 7 (10%) had died, 5 (7.3%) were lost to follow-up and 5 (7.3%) were transferred out. Rural maternal residence, lack of maternal ART/ARV prophylaxis, mixed infant feeding and infant birth weight less than 2.5 kg correlated with an HIV-positive status for infant final outcomes. Conclusion The final HIV positivity rate of 2.8% is encouraging, but is not population-based. Nevertheless, supported by our findings, we recommend continued programmatic focus on early access to quality prenatal care and maternal ART for pregnant women, especially for women living with HIV in rural areas. Furthermore, implementation of nationwide sensitization and education on six-months’ exclusive infant breastfeeding with concurrent maternal ART should be strengthened and sustained to reduce MTCT rates.

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“…Characteristics of included studies are summarised in Table 1[13,18,19,26–82]. Twenty-six (43%) prospective and 35 (57%) retrospective cohort studies analysed data from 409 781 women in 27 countries (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Adverse perinatal outcomes associated with HAART and monotherapy: systematic review and meta-analysis

Portwood

Murray

Sexton

et al. 2022

Aids

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Objectives:Assess adverse perinatal outcomes in pregnant women living with HIV (WLHIV) receiving HAART or zidovudine (ZDV) monotherapy, compared with antiretroviral therapy (ART)-naive WLHIV and HIV-negative women.Design:Systematic review and meta-analysis.Methods:We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published between 1 January 1980 and 20 April 2020. We included studies reporting on the association of pregnant WLHIV receiving HAART or ZDV monotherapy with 11 perinatal outcomes: preterm birth (PTB), very PTB, spontaneous PTB (sPTB), low birth weight (LBW), very LBW, term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted.Results:Sixty-one cohort studies assessing 409 781 pregnant women were included. WLHIV receiving ZDV monotherapy were associated with a decreased risk of PTB [relative risk 0.70, 95% confidence interval (CI) 0.62–0.79] and LBW (0.77, 0.67–0.88), and comparable risk of SGA, compared with ART-naive WLHIV. WLHIV receiving ZDV monotherapy had a comparable risk of PTB and LBW, and an increased risk of SGA (1.16, 1.04–1.30) compared with HIV-negative women. In contrast, WLHIV receiving HAART were associated with a comparable risk of PTB and LBW, and increased risk of SGA (1.38, 1.09–1.75), compared with ART-naive WLHIV. WLHIV receiving HAART were associated with an increased risk of PTB (1.55, 1.38–1.74), sPTB (2.09, 1.48–2.96), LBW (1.79, 1.51–2.13), term LBW (1.88, 1.23–2.85), SGA (1.80,1.34–2.40), and VSGA (1.22, 1.10–1.34) compared with HIV-negative women.Conclusion:Pregnant WLHIV receiving HAART have an increased risk of a wide range of perinatal outcomes compared with HIV-negative women.

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Comparison of 6-week PMTCT outcomes for HIV-exposed and HIV-unexposed infants in the era of lifelong ART: Results from an observational prospective cohort study

Cited by 6 publications

References 22 publications

Perinatal outcomes in women living with HIV‐1 and receiving antiretroviral therapy—a systematic review and meta‐analysis

Perinatal outcomes in women living with HIV‐1 and receiving antiretroviral therapy—a systematic review and meta‐analysis

Final HIV status outcome for HIV-exposed infants at 18 months of age in nine states and the Federal Capital Territory, Nigeria

Adverse perinatal outcomes associated with HAART and monotherapy: systematic review and meta-analysis

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