Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Apr 5:13:30.
doi: 10.1186/s12978-016-0149-5.

Is protease inhibitors based antiretroviral therapy during pregnancy associated with an increased risk of preterm birth? Systematic review and a meta-analysis

Yonatan Moges Mesfin  1 , Kelemu Tilahun Kibret  2 , Amsalu Taye  3
Affiliations
Meta-Analysis

Is protease inhibitors based antiretroviral therapy during pregnancy associated with an increased risk of preterm birth? Systematic review and a meta-analysis

Yonatan Moges Mesfin et al. Reprod Health. .

Abstract

Background: Antiretroviral therapy is recommended during pregnancy to decrease the risk of perinatal transmission of HIV-1 infection and to improve maternal health. However, some studies have reported that antiretroviral treatment (ART) containing protease inhibitors (PI) is associated with an increased risk of preterm birth. In contrast, other studies have reported no increased risk. This meta-analysis was conducted to derive a more reliable estimate of the association between the prenatal use of PI based ART regimen and preterm birth.

Methods: A systemic review and meta-analysis was conducted using published studies which were identified through a computerized search using the Medline/PubMed database, Google Scholar and Health Inter Network Access to Research Initiative (HINARI). The analysis was undertaken using STATA version 11.0 software and studies were described by forest plot. Heterogeneity across studies was checked using Cochran Q test and I2 test. An adjusted odd ratio with 95% confidence intervals [95% CI] was pooled using a random effects model.

Results: The Cochrane Q test (Q test p = 0.051) showed a good homogeneity among studies. However, medium heterogeneity was observed in up to 46% of the sample using the I2 test (I2 = 46.5%). The Egger weighted regression method (p = 0.04) showed evidence of publication bias, but Begg rank correlation statistics (p = 0.47) did not show evidence of publication bias. The pooled analysis of 10 studies showed that protease based ART exposure during pregnancy was associated with an increased risk of preterm birth (pooled odds ratio 1.32 (95% CI, 1.04 to 1.59).

Conclusions: This meta-analysis revealed that the PI based ART exposure during pregnancy is significantly associated with an increased risk of preterm birth. There should be strong cautions against initiating ART during pregnancy and PI based ARV should be replaced by others drug regime. Protease inhibitor ART drugs should not be included as part of therapy during pregnancy.

Keywords: Antiretroviral therapy; HIV; Pregnancy; Prematurity; Preterm birth; Protease inhibitors; Risk factors.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow chart diagram describing selection of studies for a systematic review (identification, screening, eligible and included studies). Articles may have been excluded for more than one reason
Fig. 2
Fig. 2
Funnel plot of with 95 % confidence limit; the horizontal line in the funnel plot indicates the effect estimate, while the sloping lines indicate the expected 95 % confidence intervals
Fig. 3
Fig. 3
Begg’s funnel plot with 95 % confidence limit; the horizontal line in the funnel plot indicates the natural logarithms of the effect estimate, while the sloping lines indicate the expected 95 % confidence intervals
Fig. 4
Fig. 4
Forest plot of the 10 observational studies that quantitatively assessed the association between PI based ART and preterm birth. Size of the square is proportional to the precision of the study-specific effect estimates, and the bars indicate the corresponding 95 % CIs. The diamond is centered on the summary OR of the studies, and the width indicates the corresponding 95 % CI
Fig. 5
Fig. 5
Forest plot of the 10 observational studies that quantitatively assessed the association between PI based ART and preterm birth by time of ART initiation during pregnancy
See this image and copyright information in PMC

References

    1. World Health Organization. Antiretroviral drugs for treating pregnant women and preventing HIV infections in infants: recommendations for a public health approach 2010 version. http://whqlibdoc.who.int/publications/2010. - PubMed
    1. Copper ER, Charurat M, Mofenson L, Hanson IC, Pitt J, Diaz C, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1 infected women and prevention of prenatal HIV-1 transition. J Aquir Immune Defic Syndr. 2002;29(5):484–494. doi: 10.1097/00042560-200204150-00009. - DOI - PubMed
    1. Delicio AM, Milanez H, Amaral E, Morais SS, Lajos GJ, PintoeSilva JC, et al. Mother-to-child transmission of human Immune deficiency virus in a ten years period. BMC Reproductive Health 2011; 8(35):doi:10.1186/742-4755-8-35. - PMC - PubMed
    1. Senise JF, Castelo A, Martinez M. Current treatment strategies, complications and considerations for the use of HIV antiretroviral therapy during pregnancy. AIDS Rev. 2011;13:198–213. - PubMed
    1. Ciaranello AL, Seage GR, Freedberg KA, Weinstein MC, Lockman S, Walensky RP. Antiretroviral drugs for preventing mother-to-child Transmission of HIV in sub-Saharan Africa: balancing efficacy and infant toxicity. AIDS. 2008;22(17):2359–2369. doi: 10.1097/QAD.0b013e3283189bd7. - DOI - PMC - PubMed

MeSH terms

Substances