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Fekadu Mazengia Alemu 1 Article
Does antiretroviral therapy cause congenital malformations? A systematic review and meta-analysis
Fekadu Mazengia Alemu, Alemayehu Worku Yalew
Epidemiol Health. 2021;43:e2021008.   Published online February 3, 2021
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  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
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).
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.
The electronic searches yielded 765 items. After quality assessment and grading, 30 studies were suitable for metaanalysis. 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%).
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.
Key Message
New drugs are coming to the market and effective ART is available, yet toxicity issues and harmful outcomes during pregnancy, including major congenital anomalies, preterm delivery, anemia, and low birth weight, are of increasing concern among clinicians and program managers. In the development of either WHO or National ARV guidelines, clinical management of patients therefore, careful consideration should be taken in the inclusion of PI-based inhibitors, integrase inhibitors, Zidovudine, and newer drugs. Establishing a congenital anomalies surveillance system is recommended.


Citations to this article as recorded by  
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