Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis

Wedi, Chrystelle O O; Kirtley, Shona; Hopewell, Sally; Corrigan, Ruth; Kennedy, Stephen; Hemelaar, Joris

doi:10.1016/s2352-3018(15)00207-6

Cited by 187 publications

(154 citation statements)

References 52 publications

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“…In a multivariable regression analysis adjusting for demographic characteristics and antiretroviral use in pregnant women from the same catchment population as our study, HIV-1 infection in the absence of antiretroviral treatment remained strongly associated with an increased odds of preterm delivery, stillbirths, low birth weight and small for gestational age 9. A recent meta-analysis of 35 studies showed consistent evidence of a strong association between maternal HIV-1 infection and preterm birth, low birth weight, miscarriages and stillbirths, largely in Sub-Saharan Africa 20. The Lancet HIV meta-analysis underscored the implications of not providing antiretroviral treatment to pregnant women 20…”

Section: Discussionsupporting

confidence: 70%

Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study

Moodley

Sartorius

Madurai³

et al. 2017

Sex Transm Infect

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Objectives Genital herpes simplex virus-2 (HSV-2) shedding in pregnant women in association with neonatal herpes infection has been widely studied but there is limited evidence of its association with pregnancy outcomes. Methods In this retrospective observational study, we included a subgroup of pregnant women who were enrolled in a randomized control behavioural intervention study that was conducted in South Africa in [2008][2009][2010]. In pregnancy, women had a HIV rapid test done and a genital swab taken to test for curable STIs and HSV-2 DNA. Subsequent visits were scheduled for 6, 10, 14 weeks and 9 months post-delivery. Pregnancy outcomes were documented at the 6-week or 10-week postpartum visit. Women were treated syndromically for curable STIs. Results Among 615 women included in this data analysis, 36.6% (n=225) tested HIV positive and 8.3% (n=51) tested positive for genital HSV-2 shedding during pregnancy. Women <24 years and HIV-1 seropositive women were 1.5 and 2.5 times more likely to test positive for HSV-2 genital shedding respectively. STI treatment records were available for 158/205 (77.1%) women; all 87 women with symptomatic STIs were treated the same day, and 50/71 (70.4%) asymptomatic women received treatment at the subsequent visit. Remaining 21 (29.6%) asymptomatic women did not receive treatment because they failed to return for antenatal follow-up. In a multivariable regression analysis, genital HSV-2 shedding, HIV-1, Neisseria gonorrhoea, Chlamydia trachomatis and Trichomanas vaginalis were not associated with preterm deliveries, still births and low birth weight. However with stratification by treatment for a STI, asymptomatic women who were not treated were 3.3 times more likely to deliver prematurely (33.3%; n=6/18) when compared to women who were treated during pregnancy (13.2%; n=15/114) ( p=0.042). Conclusions Genital HSV-2 shedding in pregnancy does not appear to alter pregnancy outcomes. Untreated curable STIs (T.vaginalis, C.trachomatis, N.gonorrhoea) were more likely associated with preterm births.

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Section: Discussionsupporting

confidence: 70%

Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study

Moodley

Sartorius

Madurai³

et al. 2017

Sex Transm Infect

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“…One of the causes might be maternal hypergammaglobulinemia associated with chronic HIV infection that could compete with specific maternal IgG at the level of the FcRn (33). Uncontrolled HIV infection and the use of combination antiretroviral therapy (cART) are both associated with preterm delivery (40–42), which results in lower concentrations of maternally derived antibodies.…”

Section: Transfer Of Gbs-specific Maternal Antibodiesmentioning

confidence: 99%

Increased Risk of Group B Streptococcus Invasive Infection in HIV-Exposed but Uninfected Infants: A Review of the Evidence and Possible Mechanisms

et al. 2016

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Group B Streptococcus (GBS) is a major cause of neonatal sepsis and mortality worldwide. Studies from both developed and developing countries have shown that HIV-exposed but uninfected (HEU) infants are at increased risk of infectious morbidity, as compared to HIV-unexposed uninfected infants (HUU). A higher susceptibility to GBS infections has been reported in HEU infants, particularly late-onset diseases and more severe manifestations of GBS diseases. We review here the possible explanations for increased susceptibility to GBS infection. Maternal GBS colonization during pregnancy is a major risk factor for early-onset GBS invasive disease, but colonization rates are not higher in HIV-infected compared to HIV-uninfected pregnant women, while selective colonization with more virulent strains in HIV-infected women is suggested in some studies. Lower serotype-specific GBS maternal antibody transfer and quantitative and qualitative defects of innate immune responses in HEU infants may play a role in the increased risk of GBS invasive disease. The impact of maternal antiretroviral treatment and its consequences on immune activation in HEU newborns are important to study. Maternal immunization presents a promising intervention to reduce GBS burden in the growing HEU population.

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“…In the pre-ART era, adverse birth outcomes among HIV-infected women were the result of advanced maternal immunosuppression, high viral load and opportunistic infections (OIs) [36]. Women on ART prior to conception typically have high median CD4 counts, suppressed viral loads and are thus generally not at high risk for OIs.…”

Section: In-utero Antiretroviral Therapy Exposurementioning

confidence: 99%

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

Zash

Williams

Sibiude

et al. 2016

Expert Opinion on Drug Safety

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Introduction The use of antiretroviral therapy (ART) in pregnancy to prevent vertical HIV transmission has been one of the most successful public health programs in the last decade. As a result, an unprecedented number of women are taking ART at conception and during pregnancy. Given few randomized studies evaluating safety of different ART regimens in pregnancy, ongoing drug safety surveillance is critical. Areas Covered This review aims to provide a rationale for ART drug safety surveillance, describe changing patterns of ART use and summarize current surveillance efforts in both low-resource and high-resource settings. Additionally, biostatistical approaches to and challenges in analysis of observational surveillance data are discussed. Expert Opinion The global landscape of ART use in pregnancy is rapidly increasing and evolving. Any increase in adverse effects of in-utero exposure to ART has the potential to reduce the impact of improvements in infant morbidity and mortality gained from decreased vertical HIV transmission. ART drug safety surveillance should therefore be a critical piece of programs to prevent mother to child transmission in both high- and low-resource settings. Current surveillance efforts could be strengthened with long-term follow-up of exposed children, pooling of data across cohorts and standardized approaches to analysis.

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Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis

Abstract: None.

Cited by 187 publications

References 52 publications

Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study

Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study

Increased Risk of Group B Streptococcus Invasive Infection in HIV-Exposed but Uninfected Infants: A Review of the Evidence and Possible Mechanisms

Surveillance monitoring for safety of in utero antiretroviral therapy exposures: current strategies and challenges

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