Screening for HIV Infection in Pregnant Women [Entered Retrospectively]

Project Summary Title and Description

Title
Screening for HIV Infection in Pregnant Women [Entered Retrospectively]
Description
Structured Abstract Background: A 2012 systematic review on HIV screening for the U.S. Preventive Services Task Force (USPSTF) found strong evidence that antiretroviral therapy (ART) greatly decreases the risk of mother-to-child HIV transmission but that use of ART may be associated with increased risk of preterm delivery. The USPSTF previously found HIV screening tests to be highly accurate. Purpose: To systematically update the 2012 USPSTF review on HIV screening in pregnancy, focusing on research gaps identified in the prior review. Data Sources: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and MEDLINE (2012 to June 2018) and manually reviewed reference lists, with surveillance through January 25, 2019. Study Selection: We selected randomized, controlled trials (RCTs) and cohort studies of pregnant women that reported risk of mother-to-child transmission or maternal or infant harms associated with prenatal HIV screening or ART during pregnancy. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): We identified no studies on the benefits or harms of prenatal HIV screening versus no screening, or on the yield of repeat versus one-time screening or screening at different intervals. One new RCT and five new cohort studies were consistent with the 2012 USPSTF review in finding combination ART highly effective at reducing the risk of mother-to-child transmission of HIV infection, especially if started early in pregnancy (rate of mother-to-child transmission <1%). As in the prior USPSTF review, one new RCT and several observational studies found certain ART regimens associated with increased risk of preterm delivery without increased risk of low birth weight. One RCT conducted in Africa found prenatal tenofovir-based ART associated with very preterm delivery and early infant death versus zidovudine-based ART, but the trial had methodological limitations. Prenatal exposure to most currently recommended ART drugs was not associated with increased risk of overall birth defects, but limited evidence found certain ART agents and regimens associated with increased risk of congenital abnormalities, cardiac anomalies, and echocardiographic changes, with no association with adverse neurodevelopmental outcomes. Evidence on long-term maternal harms associated with short-term exposure to ART during pregnancy remains limited, with some evidence of short-term harms. Limitations: Only English-language articles were included. Observational studies were included. Studies conducted in resource-poor settings were included, which might limit applicability to screening in the United States. Conclusions: Combination ART is highly effective at reducing risk of mother-to-child HIV transmission. The USPSTF previously determined that avoidance of breastfeeding and Caesarean delivery in women with HIV ribonucleic acid levels greater than 1,000 copies/mL near the time of delivery is also effective at reducing mother-to-child transmission, and that prenatal screening is accurate at diagnosing HIV infection. Use of certain ART regimens during pregnancy is associated with increased risk of preterm delivery and may be associated with other adverse pregnancy outcomes. Although more evidence is required to better understand short- and long-term maternal and infant harms, selection of ART regimens may help mitigate or reduce harms.
Attribution
N/A
Authors of Report
N/A
Methodology description
Study Selection: We selected randomized, controlled trials (RCTs) and cohort studies of pregnant women that reported risk of mother-to-child transmission or maternal or infant harms associated with prenatal HIV screening or ART during pregnancy. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF.
PROSPERO
N/A
DOI
10.26300/7a0x-2v33
Notes
Data was entered retrospectively via the upload of the evidence and quality tables in Word. The files uploaded for this project include: Appendix Table 1. Characteristics of Studies of Antiretroviral Therapy for HIV in Pregnancy Appendix Table 2. Results of Studies of Antiretroviral Therapy for HIV in Pregnancy Appendix Table 3. Quality Assessment of Cohort Studies of Antiretroviral Therapy for HIV in Pregnancy Appendix Table 4. Quality Assessment of Randomized Trials of Antiretroviral Therapy for HIV in Pregnancy
Funding Source
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-209-2015-00009-I, Task Order No. 7)

Key Questions

1. Key Question 1. What Are the Benefits of Screening for HIV Infection in Pregnant Women on Risk of Mother-to-Child Transmission of HIV Infection?
2. Key Question 2. What Is the Yield of Repeat HIV Screening at Different Intervals in Pregnant Women, and How Does the Yield of Screening Vary in Different Risk Groups?
3. Key Question 3. What Are the Harms of Screening for HIV Infection in Pregnant Women?
4. Key Question 4. What Is the Effectiveness of Currently Recommended ART Regimens for Reducing Mother-to-Child Transmission of HIV Infection?
5. Key Question 5. What Are the Harms of Currently Recommended ART Regimens Given During Pregnancy to the Mother and Infant?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Small-for-gestational-age births in pregnant women with HIV, due to severity of HIV disease, not antiretroviral therapy.2012
Antiretroviral combination use during pregnancy and the risk of major congenital malformations.2017
PMTCT Option B+ Does Not Increase Preterm Birth Risk and May Prevent Extreme Prematurity: A Retrospective Cohort Study in Malawi.2017
Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana.2012
The Use of Protease Inhibitors in Pregnancy: Maternal and Fetal Considerations.2015
Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001-2011.2013
Risk factors for pre-term birth in a Canadian cohort of HIV-positive women: role of ritonavir boosting?2015
Prevalence of congenital anomalies in infants with in utero exposure to antiretrovirals.2012
Predictors of adverse pregnancy outcomes in women infected with HIV in Latin America and the Caribbean: a cohort study.
Antiretroviral Therapy in Relation to Birth Outcomes among HIV-infected Women: A Cohort Study.2016
Association of HIV infection with spontaneous and iatrogenic preterm delivery: effect of HAART.2012
Improved pregnancy outcomes with increasing antiretroviral coverage in South Africa.2016
Maternal Tenofovir Disoproxil Fumarate Use During Pregnancy Is Not Associated With Adverse Perinatal Outcomes Among HIV-infected East African Women: A Prospective Study.2017
In Utero ART Exposure and Birth and Early Growth Outcomes Among HIV-Exposed Uninfected Infants Attending Immunization Services: Results From National PMTCT Surveillance, South Africa.2017
Preterm delivery risk in women initiating antiretroviral therapy to prevent HIV mother-to-child transmission.2014
Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants.2012
Comparative Safety of Antiretroviral Treatment Regimens in Pregnancy.2017
Reassuring Birth Outcomes With Tenofovir/Emtricitabine/Efavirenz Used for Prevention of Mother-to-Child Transmission of HIV in Botswana.2016
In utero exposure to zidovudine and heart anomalies in the ANRS French perinatal cohort and the nested PRIMEVA randomized trial.2015
Association between prenatal exposure to antiretroviral therapy and birth defects: an analysis of the French perinatal cohort study (ANRS CO1/CO11).2014
Premature delivery in HIV-infected women starting protease inhibitor therapy during pregnancy: role of the ritonavir boost?2012
Cardiac effects of in-utero exposure to antiretroviral therapy in HIV-uninfected children born to HIV-infected mothers.2015
Safety of in utero and neonatal antiretroviral exposure: cognitive and academic outcomes in HIV-exposed, uninfected children 5-13 years of age.2014
Combination antiretroviral use and preterm birth.2013
Congenital anomalies and in utero antiretroviral exposure in human immunodeficiency virus-exposed uninfected infants.2015
Antiretroviral exposure during pregnancy and adverse outcomes in HIV-exposed uninfected infants and children using a trigger-based design.2016
Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission: a randomized trial in three African countries.2013
Use of combination neonatal prophylaxis for the prevention of mother-to-child transmission of HIV infection in European high-risk infants.2013
Factors responsible for mother-to-child HIV transmission in Ontario, Canada, 1996-2008.2014
Mother-to-child HIV transmissions in Israel, 1985-2011.2017
Maternal and foetal outcomes among 4118 women with HIV infection treated with lopinavir/ritonavir during pregnancy: analysis of population-based surveillance data from the national study of HIV in pregnancy and childhood in the United Kingdom and Ireland.2016
No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception.2015
Benefits and Risks of Antiretroviral Therapy for Perinatal HIV Prevention.2016
Antiretroviral Pregnancy Registry Interim Report for 1 January 1989 through 31 January 20182018
Birth Outcomes for Pregnant Women with HIV Using Tenofovir-Emtricitabine.2018
Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age.2018

Downloadable Data Content

Files
  • XLSX Project Data