Epidemiology and Health

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

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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.

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Original Articles

Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study: Yunsu Choi, Bo Youl Choi, Soo Min Kim, Sang Il Kim, June Kim, Jun Young Choi, Shin-Woo Kim, Joon Young Song, Youn Jeong Kim, Dae Won Park, Hyo Youl Kim, Hee-Jung Choi, Mee-Kyung Kee, Young Hyun Shin, Myeongsu Yoo; Epidemiol Health. 2019;41:e2019037. Published online September 3, 2019; DOI: https://doi.org/10.4178/epih.e2019037

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Abstract

OBJECTIVES
To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.

METHODS

The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).

RESULTS

Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).

CONCLUSIONS

Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.

Summary

Korean summary
국내 감염인은 대부분 성 접촉으로 인해 감염되었고, 감염인의 약 90%가 치료를 경험하였다. 하지만 여전히 결핵, 매독, 주폐포자충 폐렴 등과 같은 HIV 관련 질환의 유병률이 높았고, 치료를 통해 수명이 연장되어 노화 혹은 치료 약제 부작용과 관련된 HIV 비 관련 만성 질환의 유병률도 높았다. 향후 감염인의 HIV/AIDS 비 관련 질환에 대한 연구 및 사망 원인 등에 대한 후속 연구가 필요하겠다.

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Smoothed quantile residual life regression analysis with application to the Korea HIV/AIDS cohort study
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Effect of characteristics on the clinical course at the initiation of treatment for human immunodeficiency virus infection using dimensionality reduction
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Effect of antiretroviral therapy on changes in the fertility intentions of human immunodeficiency virus-positive women in Addis Ababa, Ethiopia: a prospective follow-up study: Hussen Mekonnen, Fikre Enquselassie; Epidemiol Health. 2017;39:e2017028. Published online July 16, 2017; DOI: https://doi.org/10.4178/epih.e2017028

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Abstract PDF

Abstract

OBJECTIVES
With access to antiretroviral therapy (ART), people living with human immunodeficiency virus (HIV) are able to consider childbearing to a greater extent than previously. In many cases, ART has transformed their intentions to have children. The present study aimed to assess changes in fertility intentions 12 months after ART initiation among HIV-positive women in Addis Ababa, Ethiopia.

METHODS

An institution-based follow-up study was conducted among 360 HIV-positive women in Addis Ababa. A logistic regression model was used to assess the influence of socio-demographic, reproductive health, and clinical characteristics on changes in the fertility intentions of women.

RESULTS

Overall, 40.8% (147 of 360) of the women reported that they desired to have a child in the future at the baseline visit, while 48.3% (174 of 360) did so at the 12-month follow-up. The proportion of women who reported that they desired to have a child 12 months after ART initiation was higher among ART-initiated women (55.8%, 106 of 190) than ART-naïve women (40.0%, 68 of 170). The adjusted analysis indicated that a change in fertility intentions between baseline and the follow-up visit was significantly associated with ART use (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.20 to 5.20) and marital status, with single (aOR, 5.33; 95% CI, 1.10 to 25.92) and married (aOR, 6.35; 95% CI, 1.44 to 27.99) women being more likely to report fertility intentions than divorced/widowed women.

CONCLUSIONS

ART use was a significant predictor of change in fertility intentions between the baseline and follow-up visit, which suggests that additional efforts are necessary to integrate family planning and HIV services to address the safe fertility goals of women in the study area.

Summary

Citations

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Survival and predictors of mortality among human immunodeficiency virus patients on anti-retroviral treatment at Jinka Hospital, South Omo, Ethiopia: a six years retrospective cohort study: Erdaw Tachbele, Gobena Ameni; Epidemiol Health. 2016;38:e2016049. Published online November 6, 2016; DOI: https://doi.org/10.4178/epih.e2016049

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Abstract PDF

Abstract

OBJECTIVES
The survival rate of human immunodeficiency virus (HIV)-infected patients receiving treatment in Ethiopia is poorly understood. This study aimed to determine the survival rate and predictors of mortality among HIV-infected adults on antiretroviral therapy (ART) at Jinka Hospital, South Omo, Ethiopia.

METHODS

A 6-year retrospective cohort study was conducted using 350 patient records drawn from 1,899 patients on ART at Jinka Hospital from September 2010 to August 2015. The data were analyzed using Kaplan-Meier statistics and Cox regression models.

RESULTS

Of the 350 study participants, 315 (90.0%) were censored and 35 (10.0%) died. Twenty-two (62.9%) of the deaths occurred during the first year of treatment. The total follow-up encompassed 1,995 person-years, with an incidence rate of 1.75 deaths per 100 person-years. The mean survival time of patients on highly active antiretroviral therapy (HAART) was 30.84±19.57 months. The overall survival of patients on HAART was 64.00% (95% confidence interval [CI], 61.85 to 66.21%) at 72 months of follow-up. The significant predictors of mortality included non-disclosure of HIV status (adjusted hazard ratio [aHR], 5.82; 95% CI, 1.91 to 17.72), a history of tuberculosis (aHR, 1.82; 95% CI, 1.41 to 3.51), and ambulatory (aHR, 2.97; 95% CI, 1.20 to 8.86) or bedridden (aHR, 4.67; 95% CI, 1.30 to 17.27) functional status, World Health Organization (WHO) clinical stage IV illness (aHR, 24.97; 95% CI, 2.75 to 26.45), and substance abusers (aHR, 3.72; 95% CI, 1.39 to 9.97).

CONCLUSIONS

Patients with a history of tuberculosis treatment, ambulatory or bedridden functional status, or advanced WHO clinical stage disease, as well substance abusers, should be carefully monitored, particularly in the first few months after initiating antiretroviral therapy. Patients should also be encouraged to disclose their status to their relatives.

Summary

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Haddis Birhanu, Atsede Alle, Molla Yigzaw Birhanu
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Abdi Birhanu, Tariku Dingeta, Moti Tolera
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Abewa Kebede, Fasil Tessema, Gadisa Bekele, Zerihun Kura, Hailu Merga
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Nitin Joseph, Ushasti Sinha, Nishtha Tiwari, Pritha Ghosh, Patneedi Sindhu
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