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Safety of efavirenz in the first trimester of pregnancy: an updated systematic review and meta-analysis

Ford, Nathana,b; Calmy, Alexandrac; Mofenson, Lynned

doi: 10.1097/QAD.0b013e32834cdb71
Research Letter

Evidence of the risk of birth defects with efavirenz use is limited. We updated a meta-analysis of birth defects in infants with first trimester efavirenz exposure up to July 2011. In 21 studies, there were 39 defects among live births in 1437 women receiving first trimester efavirenz [2.0%, 95% confidence interval (CI) 0.82–3.18]. The relative risk of defects comparing women on efavirenz-based (1290 live births) and nonefavirenz-based regimens (8122 live births) was 0.85 (95% CI 0.61–1.20). One neural tube defect was observed (myelomeningocele), giving an incidence of 0.07% (95% CI 0.002–0.39).

aCentre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa

bMédecins Sans Frontières

cHIV Unit, Service of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland

dPediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.

Correspondence to Dr Nathan Ford, MPH, PhD, Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Anzio Road Cape Town 7925, South Africa. E-mail: nathan.ford@msf.org

Received 5 August, 2011

Revised 26 August, 2011

Accepted 7 September, 2011

© 2011 Lippincott Williams & Wilkins, Inc.