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Systematic review
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
DOI: https://doi.org/10.4178/epih.e2021008
  • 12,831 View
  • 372 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
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 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%).
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.
Summary
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

Citations to this article as recorded by  
  • Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women
    Ahizechukwu C Eke, Rahel D Gebreyohannes, Anna M Powell
    The Lancet Infectious Diseases.2023; 23(4): e151.     CrossRef
  • Fifteen-minute consultation: How to approach the initial discussions of dysmorphism with parents
    Kate Frances Parmenter, Sharon English, Jennifer Campbell
    Archives of disease in childhood - Education & practice edition.2023; : edpract-2023-325658.     CrossRef
Original Article
Oral symptoms significantly higher among long-term khat (Catha edulis) users in Ethiopia
Ayalew Astatkie, Meaza Demissie, Yemane Berhane, Alemayehu Worku
Epidemiol Health. 2015;37:e2015009.   Published online February 19, 2015
DOI: https://doi.org/10.4178/epih/e2015009
  • 19,437 View
  • 211 Download
  • 5 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Associations between khat (Catha edulis) chewing and different adverse oral-dental health conditions have been reported, yet evidence is still lacking. This study was designed to investigate the association between long-term regular khat chewing and self-reported oral symptoms.
METHODS
A cross-sectional study was conducted on a sample of 1,255 university students in southern Ethiopia. Data on khat chewing status, a range of oral symptoms and other pertinent variables were collected using self-administered questionnaires. The association between long-term regular khat chewing and oral symptom count was investigated using negative binomial regression.
RESULTS
The mean oral symptom count among long-term regular khat chewers was 1.75 (standard deviation [SD], 2.18; standard error [SE], 0.31), whereas that among those who were not long-term regular khat chewers was 1.18 (SD, 1.68; SE, 0.10). After adjustment for other variables, long-term regular khat chewers had approximately 50% more oral symptoms than those who were not long-term chewers did (adjusted count ratio, 1.53; 95% confidence interval, 1.12 to 2.10).
CONCLUSIONS
Long-term khat chewing negatively affects the oral health of young university students.
Summary

Citations

Citations to this article as recorded by  
  • Awareness and practice of oral hygiene and its relation to socio-demographic factors among patients attending general OPD
    Tusneem Haider, Zeeshan Yousaf, Abdul Ghaffar Khan, Saman Fatima
    Pakistan BioMedical Journal.2022; 5(1): 311.     CrossRef
  • Effect of finishing protocols and staining solutions on color stability of dental resin composites
    Chamunorwa Marufu, Bernina K. Kisumbi, Olivia A. Osiro, Fred O. Otieno
    Clinical and Experimental Dental Research.2022; 8(2): 561.     CrossRef
  • Awareness and practice of oral hygiene and its relation to socio-demographic factors among patients attending general OPD
    Tusneem Haider, Zeeshan Yousaf, Abdul Ghaffar Khan, Saman Fatima
    Pakistan BioMedical Journal.2022;[Epub]     CrossRef
  • Determinants of dental caries among adolescent patients attending Hospitals in West Wollega Zone, Western Ethiopia: A case-control study
    Tsega Tola Guracho, Emiru Merdassa Atomssa, Obsa Amante Megersa, Tadesse Tolossa, Zhaoqiang Zhang
    PLOS ONE.2021; 16(12): e0260427.     CrossRef
  • Social Habits and Other Risk Factors that Cause Tooth Loss: An Associative Study Conducted in Taiz Governorate, Yemen
    Fawzia I Shaabi, Nashwan A Noman, Adel A Aladimi, Baleegh A Alkadasi, Mohammed A Alraawi, Gassan M Al-Iryani, Asaad Khalid
    The Journal of Contemporary Dental Practice.2019; 20(4): 428.     CrossRef
  • Khat (Catha edulis) and its oral health effects: An updated review
    Sadeq A. Al‐Maweri, Saman Warnakulasuriya, Abdulaziz Samran
    Journal of Investigative and Clinical Dentistry.2018;[Epub]     CrossRef
  • Khat and synthetic cathinones: emerging drugs of abuse with dental implications
    Worku Abebe
    Oral Surgery, Oral Medicine, Oral Pathology and Or.2017;[Epub]     CrossRef
  • Oral Lesions Induced by Chronic Khat Use Consist Essentially of Thickened Hyperkeratinized Epithelium
    Ochiba Mohammed Lukandu, Lionel Sang Koech, Paul Ngugi Kiarie
    International Journal of Dentistry.2015; 2015: 1.     CrossRef
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