Pub Date : 2021-06-07DOI: 10.24875/AIDSRev.M21000041
Vicente Soriano, José Vicente Fernández-Montero
The arrival of coronavirus disease (COVID-19) in Europe exploded initially in North Italy and soon thereafter at several other major European cities, including Madrid. Indeed, Madrid was the epicenter of SARSCoV-2 infection in Spain, with a dramatic surge of cases since mid-March 2020.
{"title":"COVID-19 in Madrid: Leading Pandemic Control after being the Spanish Epicenter.","authors":"Vicente Soriano, José Vicente Fernández-Montero","doi":"10.24875/AIDSRev.M21000041","DOIUrl":"https://doi.org/10.24875/AIDSRev.M21000041","url":null,"abstract":"<p><p>The arrival of coronavirus disease (COVID-19) in Europe exploded initially in North Italy and soon thereafter at several other major European cities, including Madrid. Indeed, Madrid was the epicenter of SARSCoV-2 infection in Spain, with a dramatic surge of cases since mid-March 2020.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39070273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-03DOI: 10.24875/AIDSRev.20000103
Yuanlu Shu, Chengfeng Qiu, Xiaojun Tu, Ziwei Deng, Ye Deng, Hongqiang Wang, Xiang Zhao, Zhihua Shi
A new strategy of simplification therapy shown the unique benefits in clinical treatment, by reducing pill burden and avoid drug exposure. To provide more evidence for the strategy, we compared the efficacy and safety of dolutegravir (DTG)-containing simplified dual combination antiretroviral therapy (cART) and traditional triple cART for people living with HIV/AIDS. The meta-analysis of randomized controlled trials compared DTG-containing dual therapy with triple cART. The primary outcome was virologic suppression. The secondary outcomes included CD4T cell recovery, lipids change from baseline, and adverse events (AEs). A total of 7 studies, 4852 patients were eligible, 2423 (49.9%) received DTG-based simplified dual cART, and 2429 (50.1%) received triple cART. The viral suppression rate was 94.7% at 24 weeks, 93.0% at 48 weeks, and 96.6% at 96 weeks in dual cART. The viral suppression rate of dual cART was non-inferior to triple cART at 24 weeks (risk difference [RD], -0.00; 95% confidence interval [CI] -0.02-0.01), at 48 weeks (RD, -0.01; 95% CI -0.02-0.01), and at 96 weeks (RD, -0.01; 95% CI -0.02-0.00). Sub-analysis results were consistent with the overall results. With regard to other outcomes (CD4T counts, lipids, any AEs, and AEs grade ≥ 3), there was no significant statistical difference between the two regimens. DTG-based simplified dual cART was non-inferior to triple cART in terms of efficacy and safety. This finding provides strong support for current consensus guidelines recommended the dual regimen as first-line treatment.
一种新的简化治疗策略通过减少药丸负担和避免药物暴露,在临床治疗中显示出独特的益处。为了为该策略提供更多的证据,我们比较了含多替格拉韦(DTG)的简化双联合抗逆转录病毒治疗(cART)和传统三联抗逆转录病毒治疗(cART)对HIV/AIDS感染者的疗效和安全性。随机对照试验的荟萃分析比较了含dtg的双重治疗与三联cART。主要结果是病毒学抑制。次要结局包括CD4T细胞恢复、脂质从基线变化和不良事件(ae)。共有7项研究,4852例患者入选,2423例(49.9%)接受基于dtg的简化双重cART, 2429例(50.1%)接受三重cART。双cART治疗24周时病毒抑制率为94.7%,48周时为93.0%,96周时为96.6%。在24周时,双重cART的病毒抑制率不低于三重cART(风险差[RD], -0.00;95%可信区间[CI] -0.02-0.01), 48周时(RD, -0.01;95% CI -0.02-0.01), 96周时(RD, -0.01;95% ci -0.02-0.00)。亚分析结果与总体结果一致。至于其他结果(CD4T计数、血脂、不良事件、不良事件等级≥3),两种方案之间没有显著的统计学差异。基于dtg的简化双cART在疗效和安全性方面不逊色于三重cART。这一发现为目前的共识指南推荐双方案作为一线治疗提供了强有力的支持。
{"title":"Efficacy and Safety of Triple versus Dolutegravir-based Dual Therapy in Patients with HIV-1 Infection: A Meta-analysis of Randomized Controlled Trials.","authors":"Yuanlu Shu, Chengfeng Qiu, Xiaojun Tu, Ziwei Deng, Ye Deng, Hongqiang Wang, Xiang Zhao, Zhihua Shi","doi":"10.24875/AIDSRev.20000103","DOIUrl":"https://doi.org/10.24875/AIDSRev.20000103","url":null,"abstract":"A new strategy of simplification therapy shown the unique benefits in clinical treatment, by reducing pill burden and avoid drug exposure. To provide more evidence for the strategy, we compared the efficacy and safety of dolutegravir (DTG)-containing simplified dual combination antiretroviral therapy (cART) and traditional triple cART for people living with HIV/AIDS. The meta-analysis of randomized controlled trials compared DTG-containing dual therapy with triple cART. The primary outcome was virologic suppression. The secondary outcomes included CD4T cell recovery, lipids change from baseline, and adverse events (AEs). A total of 7 studies, 4852 patients were eligible, 2423 (49.9%) received DTG-based simplified dual cART, and 2429 (50.1%) received triple cART. The viral suppression rate was 94.7% at 24 weeks, 93.0% at 48 weeks, and 96.6% at 96 weeks in dual cART. The viral suppression rate of dual cART was non-inferior to triple cART at 24 weeks (risk difference [RD], -0.00; 95% confidence interval [CI] -0.02-0.01), at 48 weeks (RD, -0.01; 95% CI -0.02-0.01), and at 96 weeks (RD, -0.01; 95% CI -0.02-0.00). Sub-analysis results were consistent with the overall results. With regard to other outcomes (CD4T counts, lipids, any AEs, and AEs grade ≥ 3), there was no significant statistical difference between the two regimens. DTG-based simplified dual cART was non-inferior to triple cART in terms of efficacy and safety. This finding provides strong support for current consensus guidelines recommended the dual regimen as first-line treatment.","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39057817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious RNA coronavirus responsible for the pandemic of the coronavirus disease 2019 (COVID-19). Recent advances in virology, epidemiology, diagnosis, and clinical management of COVID-19 have contributed to the control and prevention of this disease, but re-positivity of SARS-CoV-2 in recovered COVID-19 patients has brought a new challenge for this worldwide anti-viral battle. Reverse transcription polymerase chain reaction (RT-PCR) tests of the SARS-CoV-2 pathogen is widely used in clinical diagnosis, but a positive RT-PCR result may be multifactorial, including false positive, SARS-CoV-2 RNA fragment shedding, reinfection of SARS-CoV-2, or re-activation of COVID-19. Re-infection of SARS-CoV-2 or re-activation of COVID-19 is an indicator of live viral carriers and isolation/treatment is needed, but SARS-CoV-2 RNA fragment shedding is not. SARS-CoV-2 RNA is recently reported to integrate into the host genome, but the far-reaching outcome is currently unclear. Therefore, it is critical for appropriate manipulation and prevention of COVID-19 to distinguish these causal factors of SARS-CoV-2 re-positivity. In this review article, we updated the current knowledge of SARS-CoV-2 re-positivity in discharged COVID-19 patients with a focus on re-infection and re-activation. We proposed a hypothetical flowchart for handling of the SARS-CoV-2 re-positive cases.
{"title":"Differentials of SARS-CoV-2 Viral RNA Re-positivity in Discharged COVID-19 Patients.","authors":"Jiliang Xia, Ying Zeng, Zhenghong Tan, Ting Chen, Weilan Hu, Shulei Shuai, Deliang Cao, Xi Zeng","doi":"10.24875/AIDSRev.21000023","DOIUrl":"https://doi.org/10.24875/AIDSRev.21000023","url":null,"abstract":"<p><p>The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious RNA coronavirus responsible for the pandemic of the coronavirus disease 2019 (COVID-19). Recent advances in virology, epidemiology, diagnosis, and clinical management of COVID-19 have contributed to the control and prevention of this disease, but re-positivity of SARS-CoV-2 in recovered COVID-19 patients has brought a new challenge for this worldwide anti-viral battle. Reverse transcription polymerase chain reaction (RT-PCR) tests of the SARS-CoV-2 pathogen is widely used in clinical diagnosis, but a positive RT-PCR result may be multifactorial, including false positive, SARS-CoV-2 RNA fragment shedding, reinfection of SARS-CoV-2, or re-activation of COVID-19. Re-infection of SARS-CoV-2 or re-activation of COVID-19 is an indicator of live viral carriers and isolation/treatment is needed, but SARS-CoV-2 RNA fragment shedding is not. SARS-CoV-2 RNA is recently reported to integrate into the host genome, but the far-reaching outcome is currently unclear. Therefore, it is critical for appropriate manipulation and prevention of COVID-19 to distinguish these causal factors of SARS-CoV-2 re-positivity. In this review article, we updated the current knowledge of SARS-CoV-2 re-positivity in discharged COVID-19 patients with a focus on re-infection and re-activation. We proposed a hypothetical flowchart for handling of the SARS-CoV-2 re-positive cases.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39057818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-02DOI: 10.24875/AIDSRev.200001311
Divya Mishra, Kelli O'Laughlin, Paul Spiegel
Historically, there has been concern that conflict may exacerbate the HIV epidemic. We conducted a systematic review to examine HIV prevalence in conflict-affected populations compared to district-level or countrywide HIV prevalence. Following PRISMA guidelines, studies presenting original HIV prevalence data published between 2005 and 2020 were drawn from PubMed, Scopus, and Embase. Data extracted included HIV prevalence, methods, dates, location, and population type. Studies were assessed for bias. Ten met criteria for data extraction; all focused on populations in sub-Saharan African. Most of the studies reported on mixed population settings while one was in a refugee camp. Six reported HIV prevalence higher than district- or country-level prevalence, while four reported lower HIV prevalence. Seven demonstrated moderate-to-high likelihood of bias in sampling, and five used methods limiting their comparability with local HIV prevalence. The relationship between armed conflict and HIV prevalence remains difficult to evaluate and likely varies by socioeconomic indicators.
{"title":"A systematic review evaluating HIV prevalence among conflict-affected populations, 2005-2020.","authors":"Divya Mishra, Kelli O'Laughlin, Paul Spiegel","doi":"10.24875/AIDSRev.200001311","DOIUrl":"https://doi.org/10.24875/AIDSRev.200001311","url":null,"abstract":"<p><p>Historically, there has been concern that conflict may exacerbate the HIV epidemic. We conducted a systematic review to examine HIV prevalence in conflict-affected populations compared to district-level or countrywide HIV prevalence. Following PRISMA guidelines, studies presenting original HIV prevalence data published between 2005 and 2020 were drawn from PubMed, Scopus, and Embase. Data extracted included HIV prevalence, methods, dates, location, and population type. Studies were assessed for bias. Ten met criteria for data extraction; all focused on populations in sub-Saharan African. Most of the studies reported on mixed population settings while one was in a refugee camp. Six reported HIV prevalence higher than district- or country-level prevalence, while four reported lower HIV prevalence. Seven demonstrated moderate-to-high likelihood of bias in sampling, and five used methods limiting their comparability with local HIV prevalence. The relationship between armed conflict and HIV prevalence remains difficult to evaluate and likely varies by socioeconomic indicators.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9478562/pdf/nihms-1833212.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39198316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-12DOI: 10.24875/AIDSRev.20000108
Thomas Roland, Jean C Yombi
Many innovations, such as long-acting agents, new delivery modalities (injectable and nanoparticles), and novel paradigms (immunotherapy or dual therapy), have been introduced to facilitate the administration of antiretroviral treatment (ART) to patients infected with HIV and improve their adherence and quality of life without altering the drugs' effectiveness. Studies have investigated the use of intermittent treatment, especially weekends-off ART in HIV-suppressed patients. In this review, we analyzed data concerning intermittent ART to help determine if this strategy is reasonable for the management of patients living with HIV. The results of early studies, in 2007-2015, were encouraging, but the studies were flawed because of the small number of patients included, the absence of a control arm, and random designs with variable patterns of ART administration. From 2016, studies have included more patients, and some are prospective, randomized controlled studies. While non-nucleoside reverse transcriptase inhibitors have been most studied, treatment with integrase inhibitors also has been reported, with the findings that viral resistance did not appear when treatment failed with dolutegravir but not with raltegravir. The most recent study, QUATUOR, found that a 4-day on, 3-day off pattern was non-inferior to the continuous pattern (7 days on). Better-quality studies with long-term follow-up (96 weeks or more) are needed to determine the validity of intermittent treatment and the optimal regimens and monitoring to be used in the management of viro-logically suppressed patients living with HIV.
{"title":"Is intermittent antiretroviral therapy a satisfactory strategy for the management of patients living with HIV?","authors":"Thomas Roland, Jean C Yombi","doi":"10.24875/AIDSRev.20000108","DOIUrl":"https://doi.org/10.24875/AIDSRev.20000108","url":null,"abstract":"<p><p>Many innovations, such as long-acting agents, new delivery modalities (injectable and nanoparticles), and novel paradigms (immunotherapy or dual therapy), have been introduced to facilitate the administration of antiretroviral treatment (ART) to patients infected with HIV and improve their adherence and quality of life without altering the drugs' effectiveness. Studies have investigated the use of intermittent treatment, especially weekends-off ART in HIV-suppressed patients. In this review, we analyzed data concerning intermittent ART to help determine if this strategy is reasonable for the management of patients living with HIV. The results of early studies, in 2007-2015, were encouraging, but the studies were flawed because of the small number of patients included, the absence of a control arm, and random designs with variable patterns of ART administration. From 2016, studies have included more patients, and some are prospective, randomized controlled studies. While non-nucleoside reverse transcriptase inhibitors have been most studied, treatment with integrase inhibitors also has been reported, with the findings that viral resistance did not appear when treatment failed with dolutegravir but not with raltegravir. The most recent study, QUATUOR, found that a 4-day on, 3-day off pattern was non-inferior to the continuous pattern (7 days on). Better-quality studies with long-term follow-up (96 weeks or more) are needed to determine the validity of intermittent treatment and the optimal regimens and monitoring to be used in the management of viro-logically suppressed patients living with HIV.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25600413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-24DOI: 10.24875/AIDSRev.20000044
Yu Qi, A Ailixire, Yu-Xun Gao, Rui-Li Li, Hong-Jun Li
Standards of HIV/AIDS prevention and control in some areas of China are still poor. People live longer with the use of therapeutic drugs, which may lead to an increase in the number of HIV-associated neurocognitive disorders (HAND). However, only a few multicenter and large-scale studies investigating the prevalence and incidence of HAND have been undertaken in China. While the number of HIV/AIDS cases in China is still large, the prevalence of HAND is remains unclear. The diagnosis of HAND in China is mainly based on the international diagnostic scale, to which Chinese features are added. At present, five classes of antiretroviral therapy drugs widely used in China: nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs), protease inhibitors, integrase inhibitors, and membrane fusion inhibitors (FIs). There is no specific treatment or drug for HAND in China. Efforts are needed in the following aspects: trying to understand more epidemic features of HAND in China; formulating a unified neuropsychological scale with Chinese characteristics to diagnose HAND and adopt new approaches to identify different stages of HAND; early stage (reversible) accurate hierarchical prediction and diagnosis, combined with artificial intelligence to improve the work efficiency of doctors, and to solve the failure of outpatient diagnosis cases (asymptomatic patients); and exploring and establishing a perfect system for target treatment with HAND.
{"title":"Current situation and prospect of HIV-associated neurocognitive disorder research in China: Epidemiology, research, diagnosis, and treatment status.","authors":"Yu Qi, A Ailixire, Yu-Xun Gao, Rui-Li Li, Hong-Jun Li","doi":"10.24875/AIDSRev.20000044","DOIUrl":"https://doi.org/10.24875/AIDSRev.20000044","url":null,"abstract":"<p><p>Standards of HIV/AIDS prevention and control in some areas of China are still poor. People live longer with the use of therapeutic drugs, which may lead to an increase in the number of HIV-associated neurocognitive disorders (HAND). However, only a few multicenter and large-scale studies investigating the prevalence and incidence of HAND have been undertaken in China. While the number of HIV/AIDS cases in China is still large, the prevalence of HAND is remains unclear. The diagnosis of HAND in China is mainly based on the international diagnostic scale, to which Chinese features are added. At present, five classes of antiretroviral therapy drugs widely used in China: nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs), protease inhibitors, integrase inhibitors, and membrane fusion inhibitors (FIs). There is no specific treatment or drug for HAND in China. Efforts are needed in the following aspects: trying to understand more epidemic features of HAND in China; formulating a unified neuropsychological scale with Chinese characteristics to diagnose HAND and adopt new approaches to identify different stages of HAND; early stage (reversible) accurate hierarchical prediction and diagnosis, combined with artificial intelligence to improve the work efficiency of doctors, and to solve the failure of outpatient diagnosis cases (asymptomatic patients); and exploring and establishing a perfect system for target treatment with HAND.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25512153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-16DOI: 10.24875/AIDSRev.21000004
Gregory D Howgego
HIV-1 is a retrovirus capable of establishing viral reservoirs that remain stable for extended periods under suppressive antiretroviral therapy (ART). Immune dysfunction and latency are well known to contribute to this longevity, but the respective roles of viral replication and latently infected (LI) cell proliferation under suppressive antiretroviral therapy (ART) have long been controversial. This historical review critically appraises the body of evidence regarding possible viral replication and proliferation of infected cells under ART. An ever-growing body of genetic and phylogenetic studies has demonstrated that HIV-infected cells are able to proliferate and contribute to the longevity of the reservoir in ART-treated patients. The role of ongoing replication remains controversial: it has been well established that HIV does not undergo evolution during ART or develop drug resistance, but some genetic, phylogenetic, and in vivo imaging studies have suggested that there may be ongoing replication despite this. The respective roles of viral replication and cellular proliferation in maintaining the LI reservoir remains an area of controversy. Elucidating these processes may allow us design interventions to reduce the size of the LI reservoir, increasing the length of treatment interruptions during which the virus will remain adequately suppressed, bringing us closer to a functional cure. Novel experimental techniques such as immuno-PET and digital droplet PCR (ddPCR) are increasingly being employed, and these, along with rapid particle sorting techniques currently in develop-ment, will be necessary to fully answer this question.
{"title":"How Does HIV Persist Under Antiretroviral Therapy: A Review of the Evidence.","authors":"Gregory D Howgego","doi":"10.24875/AIDSRev.21000004","DOIUrl":"https://doi.org/10.24875/AIDSRev.21000004","url":null,"abstract":"<p><p>HIV-1 is a retrovirus capable of establishing viral reservoirs that remain stable for extended periods under suppressive antiretroviral therapy (ART). Immune dysfunction and latency are well known to contribute to this longevity, but the respective roles of viral replication and latently infected (LI) cell proliferation under suppressive antiretroviral therapy (ART) have long been controversial. This historical review critically appraises the body of evidence regarding possible viral replication and proliferation of infected cells under ART. An ever-growing body of genetic and phylogenetic studies has demonstrated that HIV-infected cells are able to proliferate and contribute to the longevity of the reservoir in ART-treated patients. The role of ongoing replication remains controversial: it has been well established that HIV does not undergo evolution during ART or develop drug resistance, but some genetic, phylogenetic, and in vivo imaging studies have suggested that there may be ongoing replication despite this. The respective roles of viral replication and cellular proliferation in maintaining the LI reservoir remains an area of controversy. Elucidating these processes may allow us design interventions to reduce the size of the LI reservoir, increasing the length of treatment interruptions during which the virus will remain adequately suppressed, bringing us closer to a functional cure. Novel experimental techniques such as immuno-PET and digital droplet PCR (ddPCR) are increasingly being employed, and these, along with rapid particle sorting techniques currently in develop-ment, will be necessary to fully answer this question.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25483540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-08DOI: 10.24875/AIDSRev.20000098
Sabina O. Nduaguba, Chinyere Okoh, Jamie C. Barner, Kentya H. Ford, James P. Wilson, Kenneth A. Lawson, James N Barnes, Tasha Beretvas
Efavirenz- and protease inhibitor (PI)-based regimens remain viable options across the globe. We conducted a meta-analysis to compare the effectiveness of efavirenz-based regimens relative to PI-based regimens. EMBASE, PubMed, Cochrane, and clinicaltrials.gov were searched for randomized controlled trials conducted between 1987 and 2018 comparing efavirenz- with PI-based regimens. This was followed by title, abstract, and full-text screens. The quality of selected studies was assessed using the Cochrane risk of bias tool. Meta-analysis of the odds of virological suppression was conducted using the robust variance estimation approach. Fifteen studies met the inclusion criteria and totaled 6712 patients (efavirenz arm = 3339; PI arm = 3373), of which 1610 (24.0%) were females. Follow-up ranged from 24 to 144 weeks. Mean/median age ranged from 33 to 44 years. Mean/median baseline CD4 count ranged from 32 to 557 cells/mL while mean/median baseline viral load ranged from log10 4.5 to log10 5.5 copies/mL. Meta-analysis showed that patients receiving efavirenz-based regimens had 37% higher odds of virological suppression compared to PI-based regimens (odds ratio = 1.37, 95% confidence interval = 1.06-1.77, p = 0.02). The Egger test suggested the presence of publication bias (B = 0.927, t = 2.214, p = 0.033). The main threat to the quality of evidence was attrition bias. Regarding virological suppression, efavirenzbased regimens were more effective than PI-based regimens and, therefore, might be ideal for the management of treatment naïve patients with HIV in settings where NNRTIs and PIs are used.
依非韦伦和蛋白酶抑制剂(PI)为基础的方案仍然是全球可行的选择。我们进行了一项荟萃分析,比较以依非韦伦为基础的治疗方案与以pi为基础的治疗方案的有效性。EMBASE、PubMed、Cochrane和clinicaltrials.gov检索了1987年至2018年间进行的随机对照试验,比较了依非韦伦与基于pi的方案。接下来是标题、摘要和全文屏幕。使用Cochrane偏倚风险工具评估所选研究的质量。采用稳健方差估计方法对病毒学抑制几率进行meta分析。15项研究符合纳入标准,共计6712例患者(依非韦伦组= 3339;PI组= 3373),其中女性1610例(24.0%)。随访时间为24至144周。平均/中位年龄为33至44岁。平均/中位基线CD4计数范围为32至557细胞/mL,平均/中位基线病毒载量范围为log10 4.5至log10 5.5拷贝/mL。荟萃分析显示,接受以依非韦伦为基础的方案的患者获得病毒学抑制的几率比接受以pi为基础的方案的患者高37%(优势比= 1.37,95%可信区间= 1.06-1.77,p = 0.02)。Egger检验提示存在发表偏倚(B = 0.927, t = 2.214, p = 0.033)。对证据质量的主要威胁是损耗偏倚。在病毒学抑制方面,以依非韦伦为基础的方案比以pi为基础的方案更有效,因此可能是在使用nnrti和pi的环境中管理治疗naïve艾滋病毒患者的理想方案。
{"title":"Efavirenz versus Protease Inhibitors in Patients with HIV: A Systematic Review and Meta-Analysis","authors":"Sabina O. Nduaguba, Chinyere Okoh, Jamie C. Barner, Kentya H. Ford, James P. Wilson, Kenneth A. Lawson, James N Barnes, Tasha Beretvas","doi":"10.24875/AIDSRev.20000098","DOIUrl":"https://doi.org/10.24875/AIDSRev.20000098","url":null,"abstract":"<p><p>Efavirenz- and protease inhibitor (PI)-based regimens remain viable options across the globe. We conducted a meta-analysis to compare the effectiveness of efavirenz-based regimens relative to PI-based regimens. EMBASE, PubMed, Cochrane, and clinicaltrials.gov were searched for randomized controlled trials conducted between 1987 and 2018 comparing efavirenz- with PI-based regimens. This was followed by title, abstract, and full-text screens. The quality of selected studies was assessed using the Cochrane risk of bias tool. Meta-analysis of the odds of virological suppression was conducted using the robust variance estimation approach. Fifteen studies met the inclusion criteria and totaled 6712 patients (efavirenz arm = 3339; PI arm = 3373), of which 1610 (24.0%) were females. Follow-up ranged from 24 to 144 weeks. Mean/median age ranged from 33 to 44 years. Mean/median baseline CD4 count ranged from 32 to 557 cells/mL while mean/median baseline viral load ranged from log10 4.5 to log10 5.5 copies/mL.\u0000Meta-analysis showed that patients receiving efavirenz-based regimens had 37% higher odds of virological suppression compared to PI-based regimens (odds ratio = 1.37, 95% confidence interval = 1.06-1.77, p = 0.02). The Egger test suggested the presence of publication bias (B = 0.927, t = 2.214, p = 0.033). The main threat to the quality of evidence was attrition bias. Regarding virological suppression, efavirenzbased regimens were more effective than PI-based regimens and, therefore, might be ideal for the management of treatment naïve patients with HIV in settings where NNRTIs and PIs are used.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40566947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-24DOI: 10.24875/AIDSRev.20000110
Wei Li, Qiqiang Zhou, Lingbo Xia, Ruixiang Zou, Wei Zou
HIV-1 infection has caused a number of deaths worldwide and remains a global health concern. Combined antiretroviral therapy (cART) inhibits viral replication, prevents CD4+ T cell loss, and thus slows HIV disease progression. However, cART does not eradicate HIV-1. Infected individuals must remain on treatment for their entire lives and treatment interruption will result in viral rebound.
{"title":"Cellular and Immune Therapy for Treating HIV-1 Infection.","authors":"Wei Li, Qiqiang Zhou, Lingbo Xia, Ruixiang Zou, Wei Zou","doi":"10.24875/AIDSRev.20000110","DOIUrl":"https://doi.org/10.24875/AIDSRev.20000110","url":null,"abstract":"<p><p>HIV-1 infection has caused a number of deaths worldwide and remains a global health concern. Combined antiretroviral therapy (cART) inhibits viral replication, prevents CD4+ T cell loss, and thus slows HIV disease progression. However, cART does not eradicate HIV-1. Infected individuals must remain on treatment for their entire lives and treatment interruption will result in viral rebound.</p>","PeriodicalId":7685,"journal":{"name":"AIDS reviews","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2021-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25400749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}