Details:

Alternative Title:
J Acquir Immune Defic Syndr
Personal Author:
Nachega, Jean B. ; Uthman, Olalekan A. ; Mofenson, Lynne M. ; Anderson, Jean R. ; Kanters, Steve ; ... More +
Nachega, Jean B. ; Uthman, Olalekan A. ; Mofenson, Lynne M. ; Anderson, Jean R. ; Kanters, Steve ; Renaud, Francoise ; Ford, Nathan ; Essajee, Shaffiq ; Doherty, Meg C. ; Mills, Edward J. Less -
Description:
Background:

There are limited data on adverse effects of tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) on pregnant women and their infants.

Methods:

We conducted a systematic review of studies published between January 1980 and January 2017 that compared adverse outcomes in HIV-infected women receiving TDF- vs. non–TDF-based ART during pregnancy. The risk ratio (RR) for associations was pooled using a fixed-effects model.

Results:

Seventeen studies met the study inclusion criteria. We found that the rate of preterm (<37 weeks gestation) delivery (RR = 0.90, 95% confidence interval [CI]: 0.81 to 0.99, I2 = 59%) and stillbirth (RR = 0.60, 95% CI: 0.43 to 0.84, I2 = 72.0%) were significantly lower in women exposed (vs. not) to TDF-based ART regimen. We found no increased risk in maternal severe (grade 3) or potentially life-threatening (grade 4) adverse events (RR = 0.62; 95% CI: 0.30 to 1.29), miscarriage (RR = 1.09; 95% CI: 0.80 to 1.48), very preterm (<34 weeks gestation) delivery (RR = 1.08, 95% CI: 0.72 to 1.62), small for gestational age (RR = 0.87, 95% CI: 0.67 to 1.13), low birth weight (RR = 0.91; 95% CI: 0.80 to 1.04), very low birth weight (RR = 3.18; 95% CI: 0.65 to 15.63), congenital anomalies (RR = 1.03; 95% CI: 0.83 to 1.28), infant adverse outcomes or infant mortality (age >14 days) (RR = 0.65; 95% CI: 0.23 to 1.85), but increased neonatal mortality (age <14 days) risk (RR = 5.64, 95% CI: 1.70 to 18.79) with TDR-based ART exposure. No differences were found for anthropomorphic parameters at birth; one study reported minor differences in z-scores for length and head circumference at age 1 year.

Conclusions:

TDF-based ART in pregnancy seems generally safe for women and their infants. However, data remain limited and further studies are needed, particularly to assess neonatal mortality and infant growth/bone effects.


Subjects:
[+]
Critical Review HIV Pregnancy Tenofovir Toxicity
Source:
J Acquir Immune Defic Syndr. 2017; 76(1):1-12.
Pubmed ID:
28291053
Pubmed Central ID:
PMC5553236
Document Type:
Journal Article
Funding:
D43 TW010340/TW/FIC NIH HHS/United States ; U2G GH001536/GH/CGH CDC HHS/United States ; UM1 AI069521/AI/NIAID NIH HHS/United States
D43 TW010340/TW/FIC NIH HHS/United States ; U2G GH001536/GH/CGH CDC HHS/United States ; UM1 AI069521/AI/NIAID NIH HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:8912c76491b61651b6130727b9a696bfaaad85f2c4ef38315afca39c3a2a171b
Download URL:
https://stacks.cdc.gov/view/cdc/49136/cdc_49136_DS1.pdf
File Type:

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