{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:16:24Z","timestamp":1777536984579,"version":"3.51.4"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:00:00Z","timestamp":1654732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01 HD83113"],"award-info":[{"award-number":["R01 HD83113"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K24DK104676"],"award-info":[{"award-number":["K24DK104676"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DK040561"],"award-info":[{"award-number":["DK040561"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32AI007358"],"award-info":[{"award-number":["T32AI007358"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Combination antiretroviral therapy (cART) initiation during pregnancy reduces the risk of perinatal human immunodeficiency virus (HIV) transmission; however, studies have suggested that there may be unintended adverse consequences on birth outcomes for selected cART regimens.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed adverse birth outcomes among a prospective cohort of 1307 pregnant women with HIV in Dar es Salaam who initiated cART during the first or second trimester of a singleton pregnancy. Our primary analysis compared birth outcomes by gestational age at cART initiation among these women initiating cART in pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among women who initiated cART in pregnancy, there was no relationship of gestational age at cART initiation with the risk of fetal death or stillbirth. However, women who initiated cART before 20 weeks of gestation compared with after 20 weeks had increased risk of preterm birth (risk ratio [RR], 1.30; 95% confidence interval [CI], 1.03\u20131.67) but decreased risk of small-for-gestational age birth (RR, 0.71; 95% CI,\u2009.55\u2013.93).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>With increasing use of cART preconception and early in pregnancy, clinicians should be aware of the benefits and potential risks of cART regimens to optimize birth outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiac224","type":"journal-article","created":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T13:41:00Z","timestamp":1654782060000},"page":"687-695","source":"Crossref","is-referenced-by-count":6,"title":["Timing of Antiretroviral Therapy"],"prefix":"10.1093","volume":"226","author":[{"given":"M K","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine , Stanford, California , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paige L","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfa","family":"Muhihi","sequence":"additional","affiliation":[{"name":"Management and Development for Health , Dar es Salaam , Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P","family":"Duggan","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Boston Children\u2019s Hospital and Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nzovu","family":"Ulenga","sequence":"additional","affiliation":[{"name":"Management and Development for Health , Dar es Salaam , Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadhlun M","family":"Alwy Al-Beity","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3624-4405","authenticated-orcid":false,"given":"Nandita","family":"Perumal","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Said","family":"Aboud","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wafaie W","family":"Fawzi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim P","family":"Manji","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R","family":"Sudfeld","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"},{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"2023020112232941500_jiac224-B1","volume-title":"Global AIDS update","author":"UNAIDS","year":"2018"},{"key":"2023020112232941500_jiac224-B2","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1093\/infdis\/jis728","article-title":"Combination antiretroviral use and preterm birth","volume":"207","author":"Watts","year":"2013","journal-title":"J Infect Dis"},{"key":"2023020112232941500_jiac224-B3","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1093\/infdis\/jis553","article-title":"Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana","volume":"206","author":"Chen","year":"2012","journal-title":"J Infect 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