撒哈拉以南非洲地区二线抗 HIV 治疗失败：系统评价和荟萃分析。

Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis.

机构信息

Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia.

Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia.

出版信息

PLoS One. 2019 Jul 29;14(7):e0220159. doi: 10.1371/journal.pone.0220159. eCollection 2019.

DOI:10.1371/journal.pone.0220159

PMID:31356613

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6663009/

Abstract

BACKGROUND

Increased second-line antiretroviral therapy (ART) failure rate narrows future options for HIV/AIDS treatment. It has critical implications in resource-limited settings; including sub-Saharan Africa (SSA) where the burden of HIV-infection is immense. Hence, pooled estimate for second-line HIV treatment failure is relevant to suggest valid recommendations that optimize ART outcomes in SSA.

METHODS

We retrieved literature systematically from PUBMED/MEDLINE, EMBASE, CINAHL, Google Scholar, and AJOL. The retrieved studies were screened and assessed for eligibility. We also assessed the eligible studies for their methodological quality using the Joanna Briggs Institute's appraisal checklist. The pooled estimates for second-line HIV treatment failure and its associated factors were determined using STATA, version 15.0 and MEDCALC, version 18.11.3, respectively. We assessed publication bias using Comprehensive Meta-analysis software, version 3. Detailed study protocol for this review/meta-analysis is registered and found on PROSPERO (ID: CRD42018118959).

RESULTS

A total of 33 studies with the overall 18,550 participants and 19,988.45 person-years (PYs) of follow-up were included in the review. The pooled second-line HIV treatment failure rate was 15.0 per 100 PYs (95% CI: 13.0-18.0). It was slightly higher at 12-18 months of follow-up (19.0/100 PYs; 95% CI: 15.0-22.0), in children (19.0/100 PYs; 95% CI: 14.0-23.0) and in southern SSA (18.0/100 PYs; 95% CI: 14.0-23.0). Baseline values (high viral load (OR: 5.67; 95% CI: 13.40-9.45); advanced clinical stage (OR: 3.27; 95% CI: 2.07-5.19); and low CD4 counts (OR: 2.80; 95% CI: 1.83-4.29)) and suboptimal adherence to therapy (OR: 1.92; 95% CI: 1.28-2.86) were the factors associated with increased failure rates.

CONCLUSION

Second-line HIV treatment failure has become highly prevalent in SSA with alarming rates during the 12-18 month period of treatment start; in children; and southern SSA. Therefore, the second-line HIV treatment approach in SSA should critically consider excellent adherence to therapy, aggressive viral load suppression, and rapid immune recovery.

摘要

背景

二线抗逆转录病毒疗法（ART）失败率的增加缩小了 HIV/AIDS 治疗的未来选择。在资源有限的环境中，包括撒哈拉以南非洲（SSA），这一问题尤为突出，因为 HIV 感染负担巨大。因此，对二线 HIV 治疗失败的汇总估计有助于提出有效的建议，从而优化 SSA 的 ART 治疗效果。

方法

我们从 PUBMED/MEDLINE、EMBASE、CINAHL、Google Scholar 和 AJOL 系统地检索文献。筛选检索到的文献以确定其是否符合纳入标准。我们还使用 Joanna Briggs 研究所的评估清单评估了合格研究的方法学质量。使用 STATA 版本 15.0 和 MEDCALC 版本 18.11.3 分别确定二线 HIV 治疗失败的汇总估计及其相关因素。我们使用 Comprehensive Meta-analysis 软件评估发表偏倚。本综述/荟萃分析的详细研究方案已在 PROSPERO（ID：CRD42018118959）上注册。

结果

共有 33 项研究纳入了总共 18550 名参与者和 19988.45 人年（PYs）的随访数据。本研究中，二线 HIV 治疗失败率为 15.0/100 PYs（95%CI：13.0-18.0）。在 12-18 个月的随访期间，该比例略高（19.0/100 PYs；95%CI：15.0-22.0），在儿童中（19.0/100 PYs；95%CI：14.0-23.0）和在 SSA 南部（18.0/100 PYs；95%CI：14.0-23.0）。基线值（高病毒载量（OR：5.67；95%CI：13.40-9.45）；晚期临床分期（OR：3.27；95%CI：2.07-5.19）；低 CD4 计数（OR：2.80；95%CI：1.83-4.29））和治疗依从性欠佳（OR：1.92；95%CI：1.28-2.86）是与失败率增加相关的因素。