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Use of antiretroviral therapy during pregnancy and adverse birth outcomes among women living with HIV-1 in low and middle-income countries: a systematic review

Saleska, Jessica Londeree1; Turner, Abigail Norris2; Maierhofer, Courtney2; Clark, Jan2; Kwiek, Jesse J.3

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 25, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000001770
Original Article: PDF Only

Background: Worldwide, nearly 18 million women of reproductive age are living with HIV-1. Although increased access to antiretroviral therapy (ART) during pregnancy has significantly reduced HIV-1 mother-to child transmission (MTCT), a similarly robust reduction in pre-term birth (PTB) and low birth weight (LBW) among infants born to women living with HIV has not been observed. This study was designed to identify associations between classes of ART regimens and risk of PTB or LBW.

Setting: Low- and middle-income countries (LMICs).

Methods: We conducted a systematic review of randomized and observational studies that assessed the effect of ART regimen on the risk of PTB (≤37 completed weeks of gestation) or LBW (<2500 grams at birth) among pregnant women in LMICs living with HIV-1. We searched Medline, COCHRANE, Web of Science, SCOPUS, and CPCI-S for included studies.

Results: When compared to monotherapy, both non-nucleoside reverse transcriptase inhibitor (NNRTI)- and protease-inhibitor (PI)-based regimens had a consistent, harmful association with LBW. There is mixed evidence suggesting both potential harm and potential benefit for most other regimens on risk of LBW and PTB, and the harmful or protective effects of certain regimens varies depending on the drug backbone.

Conclusion: Although the benefits of ART during pregnancy for prevention of MTCT are undisputed, this systematic review indicates that ART regimens vary substantially in their association with LBW and PTB. While challenging, optimization of ART regimens could simultaneously promote maternal health, prevent MTCT, and also minimize risks of PTB and LBW.

1Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH 43210, USA

2Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, OH 43210, USA

3Department of Microbiology, College of Arts & Sciences, Ohio State University, Columbus, OH 43210, USA

Correspondence: Jesse J. Kwiek, Ph.D. Address: 484 W 12th Ave, Columbus, OH 43210 Phone: (614) 292-3256; Email:

The authors report no conflicts of interest related to this work.

Presentation of Findings: STI & HIV-1 World Congress (Poster presentation), Rio de Janeiro, Brazil, July 12th, 2017

Sources of Support: The authors did not receive direct financial support for this work.

Disclosure of Funding: No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

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