Introduction Children born to HIV-infected women are at increased risk for adverse birth outcomes including preterm birth (PTB) and low birthweight (LBW). While antiretroviral therapy (ART) during pregnancy drastically reduces risk of vertical HIV transmission, LBW and PTB among HIV-exposed infants remains elevated. Exposure to certain ART regimens in utero may increase risk of adverse birth outcomes, in particular protease inhibitor (PI)-based regimens. Given the high burden of LBW and PTB in low- and middle-income countries, and efforts to increase ART use by HIV-infected pregnant women, it is critical to understand the precise effects of ART on adverse birth outcomes.
Methods We conducted a systematic review of the effects of different ART regimens used during pregnancy on LBW or PTB in low and middle income-countries. We searched electronic databases Medline, COCHRANE, Web of Science and SCOPUS, and CPCI-S for relevant papers published on or before 10 April 2016.
Results Our final review included 19 studies and assessed many ART regimens. Results were often heterogeneous. We observed no clear pattern for the effect of PI-based highly active antiretroviral therapy (HAART) on PTB compared to no therapy, or compared to non-PI-based HAART. We similarly saw no clear trends for the effect of non PI-based HAART on LBW compared to no therapy. In contrast, PI-based HAART was generally protective against LBW when compared to non-PI-based HAART and no therapy, and non PI-based HAART was generally associated with an increased risk of LBW when compared to monotherapy. Results were similar in unadjusted studies and those that controlled for maternal disease severity and other confounders.
Conclusion There is a wide array of ART regimens used by HIV-positive pregnant women in low- and middle-income countries, as well as the heterogeneity of results related to the adverse birth outcomes of PTB and LBW. Nonetheless, we found that PI-based HAART was generally protective against LBW when compared to non-PI-based HAART.