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Antiretroviral therapy and preterm delivery—a pooled analysis of data from the United States and Europe

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Abstract:

Please cite this paper as: Townsend C, Schulte J, Thorne C, Dominguez K, Tookey P, Cortina-Borja M, Peckham C, Bohannon B, Newell M, for the Pediatric Spectrum of HIV Disease Consortium, the European Collaborative Study and the National Study of HIV in Pregnancy and Childhood. Antiretroviral therapy and preterm delivery—a pooled analysis of data from the United States and Europe. BJOG 2010;117:1399–1410. Objective 

To investigate reported differences in the association between highly active antiretroviral therapy (HAART) in pregnancy and the risk of preterm delivery among HIV-infected women. Design 

Combined analysis of data from three observational studies. Setting 

USA and Europe. Population 

A total of 19 585 singleton infants born to HIV-infected women, 1990–2006. Methods 

Data from the Pediatric Spectrum of HIV Disease project (PSD), a US monitoring study, the European Collaborative Study (ECS), a consented cohort study, and the National Study of HIV in Pregnancy and Childhood (NSHPC), the United Kingdom and Ireland surveillance study. Main outcome measure 

Preterm delivery rate (<37 weeks of gestation). Results 

Compared with monotherapy, HAART was associated with increased preterm delivery risk in the ECS (adjusted odds ratio [AOR] 2.40, 95% CI 1.49–3.86) and NSHPC (AOR 1.43, 95% CI 1.10–1.86), but not in the PSD (AOR 0.92, 95% CI 0.67–1.26), after adjusting for relevant covariates. Because of heterogeneity, data were not pooled for this comparison, but heterogeneity disappeared when HAART was compared with dual therapy (P = 0.26). In a pooled analysis, HAART was associated with 1.5-fold increased odds of preterm delivery compared with dual therapy (95% CI 1.19–1.87, P = 0.001), after adjusting for covariates. Conclusions 

Heterogeneity in the association between HAART and preterm delivery was not explained by study design, adjustment for confounders or a standard analytical approach, but may have been the result of substantial differences in populations and data collected. The pooled analysis comparing HAART with dual therapy showed an increased risk of preterm delivery associated with HAART.

Keywords: HIV; Highly active antiretroviral therapy; pregnancy; premature birth

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1471-0528.2010.02689.x

Affiliations: 1: MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK 2: National Center for HIV/Viral Hepatitis/STD/TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

Publication date: October 1, 2010

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