Table 2.
Antiretroviral therapies, ART comparisons, and perinatal outcomes reported by studies included in the systematic review and meta-analysis.
| Study | Number of women analyzed | Classes of ART regimens | Antiretroviral “third drugs” | Timing of ART initiation | NNRTI-ART vs PI-ART |
INSTI-ART vs PI-ART |
NRTI-ART vs PI-ART |
NRTI-ART vs NNRTI-ART |
NNRTI-ART vs INSTI-ART |
Perinatal outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Aaron et al. (33) | 183 | 63.9% PI-ART, 21.3% NNRTI-ART, 14.8% NRTI-ART |
PI: 2.7% APV, 15.8% ATV, 1.1% DRV, 20.8%, LPV/r, 1.1% FPV, 23% NFV, 15.8% RTV, 19.7% unspecified NNRTI: 1.1% EFV, 16.9% NVP, 3.3% ETR, 78.7% unspecified, NRTI: Unspecified |
Unspecified | Yes | No | Yes | Yes | No | SGA, VSGA |
| Albert et al. (34) | 477 | 77.1% PI-ART, 18.2% NNRTI-ART 4.7% INSTI-ART |
PI: IDV, NFV, DRV/c (unspecified proportions) NNRTI: NVP, EFV, RPV (unspecified proportions) INSTI: DTG, RAL, EVG/c (unspecified proportions) |
Mixed | Yes | Yes | No | No | Yes | sPTB |
| Bailey et al. (17) | 7,193 | 90.3% PI-ART, 9.7% NNRTI-ART |
PI: 92% LPV/r, 8% unspecified NNRTI: Unspecified |
Antenatal | Yes | No | No | No | No | PTB, SGA |
| Benamor Teixeira et al. (35) | 390 | 35.6% PI-ART, 45.1% NNRTI-ART 19.4% INSTI-ART |
PI: 89.7% LPV/r, 10.3% ATV/r NNRTI: 100% EFV INSTI: 100% RAL |
Antenatal | Yes | Yes | No | No | Yes | PTB, LBW, SGA |
| Chauhan et al. (36) | 87 | 7.6% PI-ART, 92.4% NNRTI-ART |
PI: 100% ATV/r NNRTI: 65.4% EFV, 34.6% NVP |
Mixed | Yes | No | No | No | No | LBW |
| Chen et al. (18) | 33,148 | 7.6% PI-ART, 92.4% NNRTI-ART |
PI: 100% LPV/r NNRTI: 100% NVP |
Mixed | Yes | No | No | No | No | PTB, SGA |
| Delicio et al. (37) | 787 | 80.8% PI-ART, 19.2% NNRTI-ART |
PI: 22.7% NFV, 72.1% LPV/r, 5.2% unspecified NNRTI: 97.2% NVP, 2.1% EFV, 0.7% unspecified |
Mixed | Yes | No | No | No | No | PTB, LBW, VLBW |
| Ejigu et al. (38) | 1,663 | 2.2% PI-ART, 97.8% NNRTI-ART |
PI: Unspecified NNRTI: 59.4% EFV 40.6% NVP |
Mixed | Yes | No | No | No | No | PTB, LBW, SGA |
| Ezechi et al. (39) | 1,843 | 6.7% PI-ART, 93.3% NNRTI-ART |
PI: Unspecified NNRTI: Unspecified |
Mixed | Yes | No | No | No | No | sPTB |
| Favarato et al. (16) | 6,073 | 68.0% PI-ART, 32.0% NNRTI-ART |
PI: 38.0% LPV/r, 62.0% unspecified NNRTI: Unspecified |
Mixed | Yes | No | No | No | No | PTB, SGA |
| Favarato et al. (40) | 10,434 | 67.5% PI-ART, 32.5% NNRTI-ART |
PI: 26.9% ATV/r, 9.4% DRV/r, 63.7% LPV/r NNRTI: 38.2% EFV 61.8% NVP |
Mixed | Yes | No | No | No | No | Stillbirth |
| Floridia et al. (41) | 794 | 78.5% PI-ART, 15.4% NNRTI-ART, 6.2% INSTI-ART |
PI: 46.7% ATV, 43.8% LPV, 7.5% DRV NNRTI: 60.6% NVP, 26.3% RPV, 4.1% EFV, 1.6% ETR INSTI: 59.2% RAL, 28.6% DTG, 10.2% EVG |
Mixed | Yes | Yes | No | No | Yes | PTB, VPTB, LBW, VLBW, SGA |
| Latham et al. (42) | 315 | 29.5% PI-ART, 20.0% NNRTI-ART, 50.5% INSTI-ART |
PI: Unspecified NNRTI: Unspecified INSTI: 28.9% RAL, 41.5% EVG, 26.4% DTG, 3.1% BIC |
Antenatal | Yes | Yes | No | No | Yes | PTB, LBW |
| Lopez et al. (43) | 156 | 67.9% PI-ART, 32.1% NNRTI-ART |
PI: Unspecified NNRTI: Unspecified |
Mixed | Yes | No | No | No | No | SGA |
| Machado et al. (44) | 696 | 68.1% PI-ART, 31.9% NNRTI-ART |
PI: Unspecified NNRTI: 100% NVP |
Mixed | Yes | No | No | No | No | PTB, LBW |
| Patel et al. (45) | 1,257 | 51.6% PI-ART, 19.3% NNRTI-ART 29.0% INSTI-ART |
PI: 71.5% ATV/r, 28.5% DRV/r NNRTI: 100% RPV INSTI: 32.9% DTG, 23.6% RAL, 43.6% EVG/c |
Mixed | Yes | Yes | No | No | Yes | PTB, VPTB, LBW, VLBW, SGA |
| Piske et al. (46) | 1,635 | 68.0% PI-ART, 18.9% NNRTI-ART, 13.1% NRTI-ART |
PI: Unspecified NNRTI: Unspecified NRTI: Unspecified |
Mixed | Yes | No | Yes | Yes | No | PTB |
| Shapiro et al. (14) | 730 | 37.7% PI-ART, 23.3% NNRTI-ART, 39.0% NRTI-ART |
PI: 100% LPV/r NNRTI: 100% NVP NRTI: 100% ABC |
Antenatal | Yes | No | Yes | Yes | No | PTB, VPTB, LBW, VLBW |
| Short et al. (15) | 331 | 40.0% PI-ART, 57.6% NNRTI-ART, 2.4% NRTI-ART |
PI: 100% Unspecified NNRTI: 100% NVP NRTI: 100% ABC |
Mixed | Yes | No | Yes | Yes | No | PTB |
| Sibiude et al. (47) | 1,597 | 96.0% PI-ART, 4.0% INSTI-ART |
PI: 46.4% LPV/r, 34.8% ATV/r, 18.7% DRV INSTI: 100% RAL |
Preconception | No | Yes | No | No | No | VSGA |
| Sibiude et al. (48) | 808 | 50.0% PI-ART, 50.0% INSTI-ART |
PI: 100% DRV/r INSTI: 87% RAL, 7.1% DTG, 5.9% EVG |
Mixed | No | Yes | No | No | No | PTB |
| Snijdewind et al. (49) | 10,795 | 66.7% PI-ART, 33.3% NNRTI-ART |
PI: Unspecified NNRTI: Unspecified |
Mixed | Yes | No | No | No | No | PTB, VPTB, LBW, VLBW, SGA |
| Szyld et al. (50) | 681 | 56.2% PI-ART, 43.8% NNRTI-ART |
PI: Unspecified NNRTI: Unspecified |
Mixed | Yes | No | No | No | No | PTB, LBW |
| Townsend et al. (19) | 4,939 | 39.7% PI-ART, 58.0% NNRTI-ART, 2.3% NRTI-ART |
PI: Unspecified NNRTI: Unspecified NRTI: Unspecified |
Mixed | Yes | No | Yes | Yes | No | PTB, VPTB |
| van der Merwe et al. (51) | 1,630 | 44.5% PI-ART, 55.4% NNRTI-ART |
PI: 100% LPV/r NNRTI: 71.6% NVP 28.4% EFV |
Mixed | Yes | No | No | No | No | PTB, LBW, VLBW, SGA |
| Watts et al. (52) | 1,869 | 79.0% PI-ART, 9.5% NNRTI-ART, 11.5% NRTI-ART |
PI: Unspecified NNRTI: Unspecified NRTI: Unspecified |
Mixed | Yes | No | Yes | Yes | No | PTB, sPTB, SGA |
| Zash et al. (53) | 46,267 | 8.0% PI-ART, 92.0% NNRTI-ART |
PI: 100% LPV/r NNRTI: 53.8% EFV 46.2% NVP |
Preconception | Yes | No | No | No | No | PTB, VPTB, SGA, VSGA, NND |
| Zash et al. (54) | 57,005 | 72.7% NNRTI-ART, 27.3% INSTI-ART |
NNRTI: 100% EFV INSTI: 100% DTG |
Antenatal | No | No | No | No | Yes | PTB, SGA, NND |
| Zash et al. (55) | 5,701 | 77.7% NNRTI-ART, 22.3% INSTI-ART |
NNRTI: 100% EFV INSTI: 100% DTG |
Preconception | No | No | No | No | Yes | PTB, VPTB, SGA, VSGA, NND |
| Zash et al. (56) | 22,828 | 74.6% NNRTI-ART 25.4% INSTI-ART |
NNRTI: 100% EFV INSTI: 100% DTG |
Antenatal | No | No | No | No | Yes | VPTB, VSGA |
ART, antiretroviral therapy; INSTI, integrase strand transfer inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor. Protease inhibitors: APV, amprenavir; ATV, atazanavir; DRV, darunavir; FPV, fosamprenavir; IDV, indinavir; LPV, lopinavir; NFV, nelfinavir; RTV, ritonavir; /r, ritonavir boosted; /c, cobicistat boosted. Non-nucleoside reverse transcriptase inhibitors: EFV, efavirenz; ETR, etravirine; NVP, nevirapine; RPV, rilpivirine. Nucleoside reverse transcriptase inhibitors: ABC, abacavir. Integrase strand transfer inhibitors: BIC, bictegravir; DTG, dolutegravir; EVG, elvitegravir; RAL, raltegravir. Perinatal outcomes: LBW, low birthweight; NND, neonatal death; PTB, preterm birth; SGA, small for gestational age; sPTB, spontaneous preterm birth; VLBW, very low birthweight; VPTB, very preterm birth; VSGA, very small for gestational age.