Evidence map›Paper›PMID 24586123›Full record

SynthesisPLoS medicine2014

Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis.

Alison L Drake, Anjuli Wagner, Barbra Richardson, Grace John-Stewart

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PLoS medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 281 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
281citing papers in PubMed, 7 pooled it
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

281 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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221 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Alison L DrakeDepartment of Global Health, University of Washington, Seattle, Washington, United States of America.
Anjuli WagnerDepartment of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Barbra RichardsonDepartment of Global Health, University of Washington, Seattle, Washington, United States of America ; Department of Biostatistics, University of Washington, Seattle, Washington, United States of America ; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
Grace John-StewartDepartment of Global Health, University of Washington, Seattle, Washington, United States of America ; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America ; Department of Medicine, University of Washington, Seattle, Washington, United States of America ; Department of Pediatrics, University of Washington, Seattle, Washington, United States of America.

Funding

Vaginal Health and the Risk of HIV-1 Acquistion in Kenyan WomenP01HD064915 · NICHD · FRED HUTCHINSON CANCER RESEARCH CENTER · PI JOHN-STEWART, GRACE C. · 2009 to 2013
$8.9M
Pediatric HIV-1 in Africa: Pathogenesis and ManagementK24HD054314 · NICHD · UNIVERSITY OF WASHINGTON · PI JOHN-STEWART, GRACE C. · 2006 to 2016
$1.2M
Optimizing Mechanisms for Identifying Older Children with Undiagnosed HIV-1F31MH099988 · NIMH · UNIVERSITY OF WASHINGTON · PI WAGNER, ANJULI DAWN · 2012 to 2015
$120k
NICHD NIH HHS K24 HD054314NICHD NIH HHS K24HD054314NICHD NIH HHS P01 HD064915NICHD NIH HHS P01HD064915NIMH NIH HHS F31 MH099988NIMH NIH HHS F31MH099988
6 · The paper itself

Abstract

backgroundWomen may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection. METHODS AND

findingsWe searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0-4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p<0.001). Risk of HIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5-2.1) or postpartum women (HR 1.1, 95% CI 0.6-1.6) than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2-3.9) or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2-4.4). However, the small number of studies limited power to detect associations and sources of heterogeneity.

conclusionsPregnancy and the postpartum period are times of persistent HIV risk, at rates similar to "high risk" cohorts. MTCT risk was elevated among women with incident infections. Detection and prevention of incident HIV in pregnancy/postpartum should be prioritized, and is critical to decrease MTCT.

Indexed as

Infectious Disease Transmission, VerticalAfricaAnti-HIV AgentsFemaleHIV InfectionsHumansIncidenceMultivariate AnalysisOdds RatioPostpartum PeriodPregnancyPregnancy Complications, InfectiousPrognosisRisk AssessmentRisk FactorsAnti-HIV Agents

Identifiers

PMID24586123
PMCPMC3934828

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.