Evidence map›Paper›PMID 28893758›Full record

SynthesisBMJ open2017

Antiretroviral therapy for pregnant women living with HIV or hepatitis B: a systematic review and meta-analysis.

Reed A Siemieniuk, Farid Foroutan, Reza Mirza, Jinell Mah Ming, Paul E Alexander, Arnav Agarwal, Olufunmilayo Lesi, Arnaud Merglen, Yaping Chang, Yuan Zhang and 5 more

Open access · goldAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 2 pooled it
2.3field-weighted citation impact, top 12% of its field
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

13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Review
  8. Article
  9. Article
  10. Observational
  11. Article
  12. Review
  13. Review
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

15 authors at 6 institutions in 4 countries.

Reed A SiemieniukDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Farid ForoutanDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Reza MirzaDepartment of Medicine, McMaster University, Hamilton, Canada.
Jinell Mah MingSouthern Alberta HIV Clinic, Alberta Health Services, Calgary, Canada.
Paul E AlexanderDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Arnav AgarwalFaculty of Medicine, University of Toronto, Toronto, Canada.
Olufunmilayo LesiGastroenterology and Hepatology Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria.
Arnaud MerglenDivision of General Pediatrics, University Hospitals of Geneva, Geneva, Switzerland.
Yaping ChangDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Yuan ZhangDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Hassan MirDepartment of Medicine, McMaster University, Hamilton, Canada.
Elliot HepworthDepartment of Medicine, McMaster University, Hamilton, Canada.
Yung LeeFaculty of Health Sciences, McMaster University, Hamilton, Canada.
Dena ZeraatkarDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Gordon H GuyattDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
Impact · CAMcMaster University · CAAlberta Health Services · CALagos University Teaching Hospital · NGUniversity Hospital of Geneva · CHUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the impact of various antiretroviral/antiviral regimens in pregnant women living with HIV or hepatitis B virus (HBV).

designWe performed random effects meta-analysis for HIV-related outcomes and network meta-analysis for HBV outcomes, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess quality separately for each outcome. DATA SOURCES: Embase and Medline to February 2017. ELIGIBILITY CRITERIA: For maternal outcomes, we considered randomised controlled trials (RCTs) comparing tenofovir-based regimens with those with alternative nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). For child outcomes, we included RCTs and comparative observational studies of tenofovir-based regimens versus alternative NRTIs regimens or, for HBV, placebo.

resultsTen studies (seven RCTs) met the inclusion criteria for maternal and child outcomes, and an additional 33 studies (12 RCTs) met the inclusion criteria for HBV-specific outcomes. The most common comparison was tenofovir and emtricitabine versus zidovudine and lamivudine. There was no apparent difference between tenofovir-based regimens and alternatives in maternal outcomes, including serious laboratory adverse events (low certainty) and serious clinical adverse events (moderate certainty). There was no difference between NRTIs in vertical transmission of HIV: 1 more per 1000, 8 fewer to 10 more, low certainty; or vertical transmission of HBV: 7 fewer per 1000, 10 fewer to 38 more, moderate certainty. We found moderate certainty evidence that tenofovir/emtricitabine increases the risk of stillbirths and early neonatal mortality (51 more per 1000, 11 more to 150 more) and the risk of early premature delivery at <34 weeks (42 more per 1000, 2 more to 127 more).

conclusionsTenofovir/emtricitabine is likely to increase stillbirth/early neonatal death and early premature delivery compared with zidovudine/lamivudine, but certainty is low when they are not coprescribed with lopinavir/ritonavir. Other outcomes are likely similar between antiretrovirals. TRIAL REGISTRATION NUMBER: PROSPERO CRD42017054392.

Indexed as

Pregnancy OutcomeAdultAnti-Retroviral AgentsDrug CombinationsEmtricitabineFemaleHepatitis BHIV InfectionsHumansInfantInfectious Disease Transmission, VerticalLamivudineLopinavirPregnancyPregnancy Complications, InfectiousRitonavirAnti-Retroviral AgentsDrug CombinationsEmtricitabineLamivudinelamivudine, zidovudine drug combinationLopinavirlopinavir-ritonavir drug combinationRitonavirTenofovirZidovudinechronic hepatitis BHIV & AIDSmother-to-child transmissionnetwork meta-analysispregnancytenofovir

Identifiers

PMID28893758
PMCPMC6027063
OpenAlexW2755950955

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.