Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
BMC Infect Dis. 2018 Jun 5;18(1):258. doi: 10.1186/s12879-018-3162-1.
It is unknown whether statin use among people living with HIV results in a reduction in all-cause mortality. We aimed to evaluate the effect of statin use on all-cause mortality among people living with HIV.
We conducted comprehensive literature searches of Medline, Embase, CINAHL, the Cochrane Library, and cross-references up to April 2018. We included randomised, quasi-randomised trials and prospective cohort studies that examined the association between statin use and cardio-protective and mortality outcomes among people living with HIV. Two reviewers independently abstracted the data. Hazard ratios (HRs) were pooled using empirical Bayesian random-effect meta-analysis. A number of sensitivity analyses were conducted.
We included seven studies with a total of 35,708 participants. The percentage of participants on statins across the studies ranged from 8 to 35%. Where reported, the percentage of participants with hypertension ranged from 14 to 35% and 7 to 10% had been diagnosed with diabetes mellitus. Statin use was associated with a 33% reduction in all-cause mortality (pooled HR = 0.67, 95% Credible Interval 0.39 to 0.96). The probability that statin use conferred a moderate mortality benefit (i.e. decreased risk of mortality of at least 25%, HR ≤ 0.75) was 71.5%. Down-weighting and excluding the lower quality studies resulted in a more conservative estimate of the pooled HR.
Statin use appears to confer moderate mortality benefits in people living with HIV.
目前尚不清楚在 HIV 感染者中使用他汀类药物是否会降低全因死亡率。我们旨在评估他汀类药物在 HIV 感染者中的全因死亡率方面的作用。
我们对 Medline、Embase、CINAHL、Cochrane 图书馆以及截至 2018 年 4 月的交叉引用进行了全面的文献检索。我们纳入了随机、半随机试验和前瞻性队列研究，这些研究检查了他汀类药物的使用与 HIV 感染者的心脏保护和死亡率结局之间的关联。两位审查员独立提取数据。使用经验贝叶斯随机效应荟萃分析汇总了风险比（HRs）。进行了多项敏感性分析。
我们纳入了 7 项研究，共 35708 名参与者。研究中他汀类药物的使用比例范围为 8%至 35%。报告的参与者中，高血压的比例范围为 14%至 35%，7%至 10%被诊断患有糖尿病。他汀类药物的使用与全因死亡率降低 33%相关（汇总 HR=0.67，95%置信区间 0.39 至 0.96）。他汀类药物使用带来中度死亡率获益的可能性（即死亡率降低至少 25%，HR≤0.75）为 71.5%。对质量较低的研究进行降权和排除会导致汇总 HR 的估计更为保守。
他汀类药物的使用似乎在 HIV 感染者中带来了中度的死亡率获益。
