| dc.description.abstract |
Background: Since the introduction of highly active antiretroviral therapy (HAART), acquired immune deficiency
syndrome (AIDS) related mortality has markedly declined. As HAART is becoming increasingly available, the
infection with human immunodeficiency virus (HIV+) in sub-Saharan Africa (SSA) is becoming a chronic condition.
While pregnancy in HIV+ women in SSA has always been considered a challenging event for the mother and the
fetus, for pregnant HIV+ women also diagnosed with epilepsy (WWE), there are additional risks as HIV increases the
odds of developing seizures due to the vulnerability of the central nervous system to other infections, immune
dysfunction, and overall metabolic disturbances. In light of a growing proportion of HIV+ WWE on HAART and an
increasing number of pregnant women accessing mother-to-child transmission of HIV programs through provision
of HAART in SSA, there is a need to develop contextualized and evidenced-based clinical strategies for the
management of epilepsy in this population. In this study, we conduct a literature scoping review to identify issues
that warrant consideration for clinical management.
Result: Twenty-three articles were retained after screening, which covered six overarching clinical aspects: status
epilepticus (SE), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), dyslipidemia, congenital
malformation (CM), chronic kidney disease (CKD), and neurological development. No studies for our population of
interest were identified, highlighting the need for a cautionary approach to be employed when extrapolating
findings.
Conclusion: High risks of CM and drug interactions with first-line antiepileptic drugs (AEDs) warrant measures to
increase the accessibility and choices of safer second-line AEDs. To ensure evidence-based management of epilepsy
within this population, the potential high prevalence of SE, CKD, dyslipidemia, and SJS/TEN and the cumulative
effect of drug-drug interactions should be considered. Further understanding of the intersections between
pregnancy and drug-drug interactions in SSA is needed to ensure evidenced-based management of epilepsy in
pregnant HIV+ WWE. To prevent SE, the barriers for AED treatment adherence in pregnant HIV+ women should be
explored. Our review underscores the need to conduct cohort studies of HIV+ WWE in reproductive age over time
and across pregnancies to capture the cumulative effect of HAART and AED to inform clinical management. |
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