Does antiretroviral therapy cause congenital malformations? A systematic review and meta-analysis

• 발행기관: 한국역학회
• 저자명: Fekadu Mazengia Alemu Alemayehu Worku Yalew
• 간행물 정보: 『Epidemiology and Health』43, 1~11쪽, 전체 11쪽
• 주제분류: 의약학 > 면역학
• 파일형태: PDF
• 발행일자: 2021.01.01

영문 초록

OBJECTIVES: This meta-analysis investigated the risk of congenital anomalies among infants of human immunodeficiency virus-infected pregnant women who were exposed to antiretroviral therapy (ART). METHODS: Cohort studies, case-control studies, randomized controlled trials, and controlled clinical trials were reviewed by searching MEDLINE/PubMed, Embase, Web of Science, Scopus, AIDSLINE, CINAHL, Cochrane Library, and Google/Google Scholar. Methodological quality was assessed using the GRADE evaluation. A DerSimonian and Laird random-effects model was used. Subgroup analyses and meta-regression were used to investigate heterogeneity. RESULTS: The electronic searches yielded 765 items. After quality assessment and grading, 30 studies were suitable for meta-analysis. In total, 1,461 congenital anomalies were found among 53,186 births. Children born to women receiving combined antiretroviral therapy (cART) had an approximately 10% higher risk of developing congenital anomalies (relative risk [RR], 1.09; 95% confidence interval [CI], 1.04 to 1.14). A subgroup analysis found no significant difference in the risk of congenital anomalies between cART and efavirenz users. However, zidovudine and protease inhibitor (RR, 1.09; 95% CI, 1.00 to 1.19) users were found to have a 10% increased risk of congenital anomalies, and integrase inhibitor users had a 60% increase in risk (RR, 1.61; 95% CI, 1.60 to 2.43). The subgroup results should be interpreted cautiously because of the moderate heterogeneity (I2=58%). CONCLUSIONS: The use of protease inhibitors, integrase inhibitors, zidovudine, and newer drugs should be carefully considered in pregnant women. Further studies are needed to address environmental, nutrition, and adherence factors related to ART. Establishing a congenital anomalies surveillance system is recommended.

목차

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

SUPPLEMENTARY MATERIALS

CONFLICT OF INTEREST

FUNDING

ACKNOWLEDGEMENTS

AUTHOR CONTRIBUTIONS

ORCID

REFERENCES

키워드

Antiretroviral therapy Congenital anomalies Protease inhibitors Integrase inhibitors Efavirenz