Yuanlu Shu1, Ziwei Deng1,2, Hongqiang Wang1,2, Yi Chen1,3, Lijialong Yuan1,2, Ye Deng1,2, Xiaojun Tu1, Xiang Zhao1,4, Zhihua Shi1,2, Minjiang Huang5, Chengfeng Qiu6,7. 1. Department of Evidence-Based Medicine and Clinical Center, The First People's Hospital of Huaihua, University of South China, Huaihua, 418000, People's Republic of China. 2. Department of Clinical Pharmacy, The First People's Hospital of Huaihua, University of South China, Huaihua, 418000, People's Republic of China. 3. Department of Intensive Care Unit, The First People's Hospital of Huaihua, University of South China, Huaihua, 418000, People's Republic of China. 4. Department of General Practice, The First People's Hospital of Huaihua, University of South China, Huaihua, 418000, People's Republic of China. 5. Hunan University of Medicine, Huaihua, 418000, People's Republic of China. whmj530@163.com. 6. Department of Evidence-Based Medicine and Clinical Center, The First People's Hospital of Huaihua, University of South China, Huaihua, 418000, People's Republic of China. qiuchengfeng0721@163.com. 7. Department of Clinical Pharmacy, The First People's Hospital of Huaihua, University of South China, Huaihua, 418000, People's Republic of China. qiuchengfeng0721@163.com.
Abstract
BACKGROUND: Integrase inhibitors (INIs)-based antiretroviral therapies (ART) are more recommended than efavirenz (EFV)-based ART for people living with HIV/AIDS (PLWHA). Yet, the advantage of integrase inhibitors in treating TB/HIV coinfection is uncertain. Therefore, the objective of this systematic review is to evaluate the effects and safety of INIs- versus EFV-based ART in TB/HIV coinfection, and demonstrate the feasibility of the regimens. METHODS: Four electronic databases were systematically searched through September 2020. Fixed-effects models were used to calculate pooled effect size for all outcomes. The primary outcomes were virologic suppression and bacteriology suppression for INIs- versus EFV-based ART. Secondary outcomes included CD4+ cell counts change from baseline, adherence and safety. RESULTS: Three trials (including 672 TB/HIV patients) were eligible. ART combining INIs and EFV had similar effects for all outcomes, with none of the point estimates argued against the INIs-based ART on TB/HIV patients. Compared to EFV-based ART as the reference group, the RR was 0.94 (95% CI 0.85 to 1.05) for virologic suppression, 1.00 (95% CI 0.95 to 1.05) for bacteriology suppression, 0.98 (95% CI 0.95 to 1.01) for adherence. The mean difference in CD4+ cell counts increase between the two groups was 14.23 cells/μl (95% CI 0- 6.40 to 34.86). With regard to safety (adverse events, drug-related adverse events, discontinuation for drugs, grade 3-4 adverse events, IRIS (grade 3-4), and death), INIs-based regimen was broadly similar to EFV-based regimens. The analytical results in all sub-analyses of raltegravir- (RAL) and dolutegravir (DTG) -based ART were valid. CONCLUSION: This meta-analysis demonstrates similar efficacy and safety of INIs-based ART compared with EFV-based ART. This finding supports INIs-based ART as a first-line treatment in TB/HIV patients. The conclusions presented here still await further validation owing to insufficient data.
BACKGROUND: Integrase inhibitors (INIs)-based antiretroviral therapies (ART) are more recommended than efavirenz (EFV)-based ART for people living with HIV/AIDS (PLWHA). Yet, the advantage of integrase inhibitors in treating TB/HIV coinfection is uncertain. Therefore, the objective of this systematic review is to evaluate the effects and safety of INIs- versus EFV-based ART in TB/HIV coinfection, and demonstrate the feasibility of the regimens. METHODS: Four electronic databases were systematically searched through September 2020. Fixed-effects models were used to calculate pooled effect size for all outcomes. The primary outcomes were virologic suppression and bacteriology suppression for INIs- versus EFV-based ART. Secondary outcomes included CD4+ cell counts change from baseline, adherence and safety. RESULTS: Three trials (including 672 TB/HIVpatients) were eligible. ART combining INIs and EFV had similar effects for all outcomes, with none of the point estimates argued against the INIs-based ART on TB/HIVpatients. Compared to EFV-based ART as the reference group, the RR was 0.94 (95% CI 0.85 to 1.05) for virologic suppression, 1.00 (95% CI 0.95 to 1.05) for bacteriology suppression, 0.98 (95% CI 0.95 to 1.01) for adherence. The mean difference in CD4+ cell counts increase between the two groups was 14.23 cells/μl (95% CI 0- 6.40 to 34.86). With regard to safety (adverse events, drug-related adverse events, discontinuation for drugs, grade 3-4 adverse events, IRIS (grade 3-4), and death), INIs-based regimen was broadly similar to EFV-based regimens. The analytical results in all sub-analyses of raltegravir- (RAL) and dolutegravir (DTG) -based ART were valid. CONCLUSION: This meta-analysis demonstrates similar efficacy and safety of INIs-based ART compared with EFV-based ART. This finding supports INIs-based ART as a first-line treatment in TB/HIVpatients. The conclusions presented here still await further validation owing to insufficient data.
Entities:
Keywords:
Dolutegravir; Efavirenz; HIV patients; Integrase inhibitors; Raltegravir; TB
Authors: Doo-Yeoun Cho; Joan H Q Shen; Suzanne M Lemler; Todd C Skaar; Lang Li; Julia Blievernicht; Ulrich M Zanger; Kwon-Bok Kim; Jae-Gook Shin; David A Flockhart; Zeruesenay Desta Journal: Drug Metab Pharmacokinet Date: 2015-07-29 Impact factor: 3.614
Authors: James Hakim; Victor Musiime; Alex J Szubert; Jane Mallewa; Abraham Siika; Clara Agutu; Simon Walker; Sarah L Pett; Mutsa Bwakura-Dangarembizi; Abbas Lugemwa; Symon Kaunda; Mercy Karoney; Godfrey Musoro; Sheila Kabahenda; Kusum Nathoo; Kathryn Maitland; Anna Griffiths; Margaret J Thomason; Cissy Kityo; Peter Mugyenyi; Andrew J Prendergast; A Sarah Walker; Diana M Gibb Journal: N Engl J Med Date: 2017-07-20 Impact factor: 91.245