Submission ID 129613
| Issue/Objective | Introduction: The World Health Organization's "treat-all" policy has expanded universal access to antiretroviral therapy (ART) for all persons living with HIV, including pregnant women. Early initiation of ART is known to reduce mother-to-child transmission (MTCT) of HIV; however, its effects on adverse perinatal outcomes remain unclear, limiting evidence-based decision-making in maternal and HIV programs. This study evaluated the association between the timing of maternal ART initiation and adverse perinatal outcomes in the treat-all era |
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| Methodology/Approach | A systematic search was conducted in major databases for studies published from 2015 onward, following PRISMA 2020 guidelines and a registered PROSPERO protocol (CRD420251238565). Primary outcomes include preterm birth, low birth weight (LBW), small for gestational age(SGA), and stillbirth. MTCT was assessed as a secondary outcome. We performed Random-effects meta-analyses to generate pooled odds ratios with 95% confidence intervals. Subgroup analyses were stratified by country income level |
| Results | Twenty-five studies, including 87,899 mother-infant pairs, were analyzed. Preconception ART initiation was associated with a modest but statistically significant increase in the odds of preterm birth (approximately 17% higher odds; pooled OR 1.17, 95% CI 1.01-1.36). Subgroup analyses suggested differences by country income level, with a significant association in HICs (OR 1.24, 95% CI 1.13-1.37) but not in LMICs. Other outcomes had no statistically significant associations: LBW (OR 1.05, 95% CI 0.96-1.15), SGA (OR 1.12, 95% CI 0.85-1.50), and stillbirth (OR 1.09, 95% CI 0.95-1.25). ART initiation before pregnancy was associated with significantly reduced odds of MTCT of HIV (approximately 60% lower odds; OR 0.40, 95% CI 0.20-0.81). Excluding high-risk studies in MTCT and SGA analysis did not materially alter the pooled effect result, strengthening confidence in the findings. No studies contributing to the other outcomes were rated as high-risk of bias |
| Discussion/Conclusion | Initiating ART pre-conception is a highly protective measure against MTCT, with a small increase for preterm birth and no impact on other adverse perinatal outcomes. These results confirm WHO recommendations on prompt lifelong ART therapy for women living with HIV, highlighting the need for the health system to strengthen preconception ART access, integrate PMTCT and antenatal services, and enhance monitoring of preterm birth as ART coverage expands |
| Presenters and Affiliations | Chisom Chukwuma The American University in Cairo Lereen Kamal The American University in Cairo Queen Onyeke Brock Universit Sungsoo Chun The American University in Cairo |
