Alzate Angel Juan Carlos, Duque Molina Marcela María, García García Héctor Iván
Corporación para Investigaciones Biológicas, CIB (Corporation for Biological Research), Medellín, Colombia.
Academic Group of Epidemiology, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia.
Colomb Med (Cali). 2017 Jun 30;48(2):70-81.
Initial treatment of the HIV is based on the use of three drugs, two of which are nucleoside analog reverse-transcriptase inhibitors. There are three combinations of these drugs which have been approved by different guidelines, each with divergent results in terms of efficacy and safety.
To compare the efficacy and safety of these three combinations.
Systematic review and network meta-analysis of randomized clinical trials comparing fixed doses of Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC), Abacavir / Lamivudine (ABC/3TC) and Zidovudine / Lamivudine (ZDV/3TC).
Seven clinical trials met the eligibility criteria. The results suggested higher efficacy with TDF/FTC vs. ABC/3TC at 96 weeks and vs. ZDV/3TC at 48 weeks. However, there is clinical and statistical heterogeneity. Subgroup analysis were performed by third drug and by level of viral load prior to treatment, and found no differences in virological control. Network meta-analysis could only be carried out with TDF/FTC vs. ZDV/3TC, and the proportion of patients with virological response, with no differences at 48 weeks nor at 96 weeks. Direct comparisons showed an increased risk of bone marrow suppression of ZDV/3TC vs. TDF/FTC and of ABC/3TC hypersensitivity reactions vs. ZDV/3TC.
The results did not show differences in effectiveness among the interventions. However, due to the heterogeneity of the third drug and the follow-up time between the included studies, this result is not definitive. The results raise the need for further studies to help improve treatment recommendations in patients infected with HIV.
HIV的初始治疗基于使用三种药物，其中两种是核苷类似物逆转录酶抑制剂。这些药物有三种组合已被不同指南批准，每种组合在疗效和安全性方面都有不同结果。
比较这三种组合的疗效和安全性。
对比较固定剂量的替诺福韦酯/恩曲他滨（TDF/FTC）、阿巴卡韦/拉米夫定（ABC/3TC）和齐多夫定/拉米夫定（ZDV/3TC）的随机临床试验进行系统评价和网状Meta分析。
七项临床试验符合纳入标准。结果表明，在96周时，TDF/FTC对比ABC/3TC疗效更高，在48周时对比ZDV/3TC疗效更高。然而，存在临床和统计学异质性。按第三种药物和治疗前病毒载量水平进行亚组分析，未发现病毒学控制方面的差异。仅对TDF/FTC对比ZDV/3TC进行了网状Meta分析，48周和96周时病毒学应答患者比例无差异。直接比较显示，ZDV/3TC对比TDF/FTC骨髓抑制风险增加，ABC/3TC对比ZDV/3TC超敏反应风险增加。
结果未显示各干预措施在有效性上存在差异。然而，由于第三种药物的异质性以及纳入研究之间的随访时间不同，该结果并不确定。结果表明需要进一步研究以帮助改进HIV感染患者的治疗建议。
