A Systematic Review on Cardiometabolic Risks and Perinatal Outcomes among Pregnant Women Living with HIV in the Era of Antiretroviral Therapy

Abstract

Antiretroviral therapy (ART) regimens have been shown to cause metabolic changes in people living with HIV (PLWH), predisposing them to cardiometabolic disease (CVMD). However, such evidence is less established in pregnant women living with HIV (pWLWH) on ART. Pregnancy-induced cardiometabolic risks (CMR) can predispose to unfavourable pregnancy outcomes and further persist in the postpartum period, resolve, and recur in subsequent pregnancies, or emerge as newly diagnosed chronic diseases of ageing. Therefore, this systematic review aimed at synthesizing evidence on CMR and perinatal outcomes among pWLWH in the era of ART. We considered prospective and retrospective cohorts, case-control, cross-sectional, and interventional studies published in English. Specific keywords were used to conduct a thorough literature search on PubMed-Medline and Scopus following the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Two investigators independently screened the search outputs and reviewed full texts of potentially eligible articles. Data extraction was conducted by one investigator and verified by the second investigator. Thirty-one relevant studies conducted on 20,904 pWLWH on ART across Africa, Asia, Europe, and America were included. Studies demonstrate inconclusive findings, especially on perinatal outcomes, but significant risks of gestational hypertension and dyslipidemia were reported in pWLWH on ART compared to the control group. Therefore, future studies should focus more on these perinatal outcomes, and their impact on postpartum maternal health and growth trajectories of uninfected infants born from pWLWH who are either on ART or ART-naïve in comparison to infants born of HIV-negative mothers over the life course, especially in HIV-burdened African countries.

Multimorbidity, Treatment, and Determinants among Chronic Patients Attending Primary Health Facilities in Tshwane, South Africa

“…South Africa is currently experiencing a convergence of NCDs and CDs [ 22 , 23 , 24 , 25 , 26 ], causing the burden of multimorbidity to range from 3% to 87% in various group populations. The common multimorbidity patterns in South Africa are combined TB and HIV, hypertension and diabetes, and hypertension and HIV [ 27 ], and to a lesser extent, the coexistence of HIV, anaemia hypertension, and/or diabetes has been reported [ 28 ].…”

“…While multimorbidity requires a complexity of care [ 13 , 31 , 32 ], most local studies have reported medication adherence from a single index point of view for hypertension, diabetes, and HIV treatments. The era of an anti-retroviral therapy (ART) programme in South Africa has improved the health of people living with HIV (PLWH) but has come along with cardiometabolic diseases [ 26 , 33 , 34 ].…”

“…The absence of integrated care in South Africa will increase the burden of multimorbidity and worsen the already burdened health systems and continues to affect the quality of individuals’ lives, especially multimorbid patients [ 23 , 26 ]. This calls for prioritized policies on the integrated management of NCDs and CDs [ 35 ], especially in a country like South Africa, which has an uneven distribution of healthcare needs from the public and private services, affecting mostly the socio-economically disadvantaged [ 36 ].…”