Andrade Hugo Boechat, Shinotsuka Cassia Righy, da Silva Ivan Rocha Ferreira, Donini Camila Sunaitis, Yeh Li Ho, de Carvalho Frederico Bruzzi, Americano do Brasil Pedro Emmanuel Alvarenga, Bozza Fernando Augusto, Miguel Japiassu Andre
Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil.
Infectious Diseases Intensive Care Unit of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil.
PLoS One. 2017 Oct 24;12(10):e0186968. doi: 10.1371/journal.pone.0186968. eCollection 2017.
It is unclear whether the treatment of an HIV infection with highly active antiretroviral therapy (HAART) affects intensive care unit (ICU) outcomes. In this paper, we report the results of a systematic review and meta-analysis performed to summarize the effects of HAART on the prognosis of critically ill HIV positive patients.
A bibliographic search was performed in 3 databases (PubMed, Web of Science and Scopus) to identify articles that investigated the use of HAART during ICU admissions for short- and long-term mortality or survival. Eligible articles were selected in a staged process and were independently assessed by two investigators. The methodological quality of the selected articles was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool.
Twelve articles met the systematic review inclusion criteria and examined short-term mortality. Six of them also examined long-term mortality (≥90 days) after ICU discharge. The short-term mortality meta-analysis showed a significant beneficial effect of initiating or maintaining HAART during the ICU stay (random effects odds ratio 0.53, p = 0.02). The data analysis of long-term outcomes also suggested a reduced mortality when HAART was used, but the effect of HAART on long-term mortality of HIV positive critically ill patients remains uncertain.
This meta-analysis suggests improved survival rates for HIV positive patients who were treated with HAART during their ICU admission.
高效抗逆转录病毒疗法（HAART）治疗HIV感染是否会影响重症监护病房（ICU）的治疗结果尚不清楚。在本文中，我们报告了一项系统评价和荟萃分析的结果，该分析旨在总结HAART对重症HIV阳性患者预后的影响。
在3个数据库（PubMed、科学网和Scopus）中进行文献检索，以确定调查在ICU住院期间使用HAART对短期和长期死亡率或生存率影响的文章。符合条件的文章通过分阶段的过程进行选择，并由两名研究人员独立评估。使用非随机研究方法学指数（MINORS）工具评估所选文章的方法学质量。
12篇文章符合系统评价纳入标准并研究了短期死亡率。其中6篇还研究了ICU出院后的长期死亡率（≥90天）。短期死亡率的荟萃分析显示，在ICU住院期间开始或维持HAART有显著的有益效果（随机效应比值比为0.53，p = 0.02）。长期结果的数据分析也表明使用HAART时死亡率降低，但HAART对HIV阳性重症患者长期死亡率的影响仍不确定。
这项荟萃分析表明，在ICU住院期间接受HAART治疗的HIV阳性患者生存率有所提高。
