Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis
Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis
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DOI：
10.1016/s2352-3018(15)00207-6
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发表时间：
2016-01-01
期刊：
影响因子：
16.1
通讯作者：
Hemelaar, Joris
中科院分区：
文献类型：
--
作者：
Wedi, Chrystelle O. O.;Kirtley, Shona;Hemelaar, Joris
背景：艾滋病毒大流行影响全球3690万人，其中150万是孕妇。91%的艾滋病毒阳性孕妇生活在撒哈拉以南非洲，该地区的围产期结局也非常糟糕。方法通过检索PubMed、CINAHL(EbScott Host)、Global Health(Ovid)、EMbase(Ovid)、Cochrane Central Register of Control Trials和4个临床试验数据库(WHO国际临床试验注册平台、泛非临床试验注册中心、ClinicalTrials.gov数据库和ISRCTN注册中心)对1980年1月1日至2014年12月7日发表的研究进行系统回顾和荟萃分析。两位作者独立回顾了通过科学文献搜索检索到的研究，确定了相关研究，并提取了数据。我们调查了未接受抗逆转录病毒治疗的妇女的母亲HIV感染与11种围产儿结局的关系：早产、极早产、低出生体重、极低出生体重、足月低出生体重、早产低出生体重、小于胎龄、极小胎龄、流产、死产和新生儿死亡。我们包括前瞻性和回溯性的队列研究和病例对照研究，报告了未接受抗逆转录病毒治疗的HIV阳性妇女和HIV阴性对照妇女的围产期结局。我们使用随机效应模型对特定的围产期结局进行荟萃分析。我们进行了分组和敏感性分析，并评估了混杂因素的调整效果。这项系统性综述和荟萃分析注册于Propero，编号为CRD42013005638。在确定的60 750项研究中，我们获得了35项研究的数据(20项前瞻性队列研究、12项回溯性队列研究和3项病例对照研究)，其中包括53 623名女性。我们的前瞻性队列研究的Meta分析显示，母亲感染HIV与早产风险增加(相对风险1.50，95%可信区间1.24-1.82)、低出生体重(1.62，1.41-1.86)、小于胎龄(1.31，1.14-1.51)和死产(1.67，1.05-2.66)相关。回溯性队列研究还表明，足月低出生体重(2.62，1.15-5.93)和早产低出生体重(3.25，2.12-4.99)的风险增加。这些关联的最有力和最一致的证据是在撒哈拉以南非洲确定的。未发现孕妇感染艾滋病毒与极早产、极小的胎龄、极低出生体重、流产或新生儿死亡之间的联系，尽管关于这些结果的数据很少。未接受抗逆转录病毒治疗的妇女的母体HIV感染与早产、低出生体重、小于胎龄和死产有关，尤其是在撒哈拉以南非洲地区。需要研究来评估抗逆转录病毒治疗方案如何影响这些围产期结局。
Background The HIV pandemic affects 36.9 million people worldwide, of whom 1.5 million are pregnant women. 91% of HIV-positive pregnant women reside in sub-Saharan Africa, a region that also has very poor perinatal outcomes. We aimed to establish whether untreated maternal HIV infection is associated with specific perinatal outcomes.Methods We did a systematic review and meta-analysis of the scientific literature by searching PubMed, CINAHL (Ebscohost), Global Health (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials and four clinical trial databases (WHO International Clinical Trials Registry Platform, the Pan African Clinical Trials Registry, the ClinicalTrials.gov database, and the ISRCTN Registry) for studies published from Jan 1, 1980, to Dec 7, 2014. Two authors independently reviewed the studies retrieved by the scientific literature search, identified relevant studies, and extracted the data. We investigated the associations between maternal HIV infection in women naive to antiretroviral therapy and 11 perinatal outcomes: preterm birth, very preterm birth, low birthweight, very low birthweight, term low birthweight, preterm low birthweight, small for gestational age, very small for gestational age, miscarriage, stillbirth, and neonatal death. We included prospective and retrospective cohort studies and case-control studies reporting perinatal outcomes in HIV-positive women naive to antiretroviral therapy and HIV-negative controls. We used a random-effects model for the meta-analyses of specific perinatal outcomes. We did subgroup and sensitivity analyses and assessed the effect of adjustment for confounders. This systematic review and meta-analysis is registered with PROSPERO, number CRD42013005638.Findings Of 60 750 studies identified, we obtained data from 35 studies (20 prospective cohort studies, 12 retrospective cohort studies, and three case-control studies) including 53 623 women. Our meta-analyses of prospective cohort studies show that maternal HIV infection is associated with an increased risk of preterm birth (relative risk 1.50, 95% CI 1.24-1.82), low birthweight (1.62, 1.41-1.86), small for gestational age (1.31, 1.14-1.51), and stillbirth (1.67, 1.05-2.66). Retrospective cohort studies also suggest an increased risk of term low birthweight (2.62, 1.15-5.93) and preterm low birthweight (3.25, 2.12-4.99). The strongest and most consistent evidence for these associations is identified in sub-Saharan Africa. No association was identified between maternal HIV infection and very preterm birth, very small for gestational age, very low birthweight, miscarriage, or neonatal death, although few data were available for these outcomes. Correction for confounders did not affect the significance of these findings.Interpretation Maternal HIV infection in women who have not received antiretroviral therapy is associated with preterm birth, low birthweight, small for gestational age, and stillbirth, especially in sub-Saharan Africa. Research is needed to assess how antiretroviral therapy regimens affect these perinatal outcomes.