Efficacy And Safety Profile Of Integrase Strand Transfer Inhibitors (instis) For Treatment Of Hiv In Pregnant Women Systematic Review And Meta-analysis

Background: Integrase strand transfer inhibitors (InSTIs) are the most recent class of drugsrnapproved on the basis of their efficacy and safety profiles (16). Dolutegravir and elvitegravir arernconsidered US Food and Drug Administration pregnancy category B; while raltegravir belongsrnto category C. rnObjective: To assess the efficacy and safety profile of Integrase Strand Transfer Inhibitors drugsrnfor treatment of HIV in Pregnant Women rnMethod: Literature search strategies were done using medical subject headings (MeSH) and textrnwords related to InSTIs drugs and pregnancy. Pubmed, EMBASE, Web of Science, SciencernDirect, Henari, and the Cochrane Central Register of Controlled Trials and other databases werernsearched. The estimated effect (Relative Risks) and associated 95% confidence intervals for thernreduction of HIV RNA viral load were meta-analyzed using a DerSimonian– Laird randomeffectsrnmodelrn(25).rnStatisticalrnanalysisrnwasrnperformedrnusingrnRevManrn5.3 software.rnrnResult: Based on our systematic review and meta-analyses data, treatment with InSTIs basedrnART regimens showed to be more beneficial for HIV positive pregnant women compared tornother currently used treatment strategies. Both preterm delivery and proportion of infants withrnSmall for Gestational Age didn’t show statistically significant association with the use of InSTIsrn(risk ratio 0.82, 95% CI 0.60–1.13, Irn2rn=0%) and (risk ratio 0.90, 95% CI 0.58–1.40, Irn=0%)rnrespectively. DTG based ART showed a lowered maternal serious adverse event compared torncurrent treatment regimen (risk ratio 1.94, 95% CI 1.13–3.32, Irn2rn=0%). rnConclusion: We suggest use of DTG based ART regimen to be preferred first line choice forrnHIV positive pregnant women, if the pregnancy is confirmed already past 8 weeks of gestation.rnAlthough further investigation is necessary about safety data, we suggest InSTI drugs, especiallyrnRAL, can be safely used during pregnancy particularly in late presenter pregnant women or as anrnintensification strategy. Because of the short and long-term consequences of adverse events seenrnin infants, particularly preterm birth and SGA, future studies need to assess the safety profile ofrnDTG for infants and explore potential mechanisms of adverse outcomes. rn2

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