HIV infekce a nepříznivé perinatální výsledky –⁠ metaanalýza předčasného porodu, nízké porodní hmotnosti a novorozenců malých na gestační věk

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Authors: K. Hurt ¹; J. Rakovic ²; J. Matěcha ¹; M. Mojhova ¹; F. Zahálka ³; M. Zikán ¹
Authors‘ workplace: Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University, Bulovka Teaching Hospital, Prague ¹; Department of Gynaecology and Obstetrics, Amedeana, Prague ²; Sports Motoric Laboratory, Faculty of Physical Education and Sport, Charles University, Prague ³
Published in: Ceska Gynekol 2025; 90(4): 269-277
Category: Original Article
doi: https://doi.org/10.48095/cccg2025269

Overview

HIV zůstává významnou globální výzvou v oblasti veřejného zdraví, která postihuje miliony lidí, přičemž největší zátěž připadá na subsaharskou Afriku. Navzdory pokroku v antiretrovirové terapii (ART) a globálním snahám o kontrolu přenosu zůstává vliv HIV na těhotenské výsledky důvodem k obavám. Cíl: Tato studie hodnotí souvislost mezi mateřskou infekcí HIV a nepříznivými těhotenskými výstupy, zejména předčasným porodem (PTB –⁠ preterm birth), nízkou porodní hmotností (LBW –⁠ low birth weight) a novorozenci malými vzhledem k danému gestačnímu věku (SGA –⁠ small for gestational age), prostřednictvím komplexní metaanalýzy. Materiál a metody: Systematické vyhledávání v anglicky psaných databázích (Medline, Web of Science, Ovid, Scopus a Google Scholar) identifikovalo relevantní studie publikované v letech 2014–2024. Zahrnuty byly retrospektivní a prospektivní kohortové studie s dobře definovanými kontrolními skupinami HIV-negativních matek. Vyloučeny byly studie bez odpovídajících kontrol, s vícečetnými těhotenstvími nebo bez adjustovaných statistických výsledků. Celkem bylo zahrnuto osm studií zaměřených na PTB, pět na LBW a pět na SGA. Výsledky: Metaanalýza prokázala významnou souvislost mezi mateřskou infekcí HIV a PTB (OR = 1,55; 95% CI 1,38–1,74; p < 0,001), LBW (OR = 1,57; 95% CI 1,24–1,98; p < 0,001) i SGA (OR = 1,24; 95% CI 1,10–1,40; p < 0,001). Heterogenita byla mírná u PTB (I² = 38,2 %), LBW (I² = 55,9 %) a nízká u SGA (I² = 7,6 %), s minimálním publikačním zkreslením dle Eggerova testu. Diskuze: Výsledky zdůrazňují negativní dopad HIV na těhotenství a potřebu optimalizace ART ke snížení rizik. Další výzkum by měl sledovat vliv různých režimů ART a dynamiku imunitního systému na vývoj plodu.

Klíčová slova:

předčasný porod – HIV – antiretrovirová terapie – nízká porodní hmotnost – malý vzhledem ke gestačnímu věku – SGA metaanalýza

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