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阿扎那韦/利托那韦与洛匹那韦/利托那韦为基础的联合抗逆转录病毒治疗（cART）用于治疗 HIV-1 感染：系统评价和荟萃分析。

Atazanavir / ritonavir versus Lopinavir / ritonavir-based combined antiretroviral therapy (cART) for HIV-1 infection: a systematic review and meta-analysis.

机构信息

Haramaya University, School of Pharmacy, Ethiopia.

Department of Pharmacoeconomics and Pharmaceutical Administration, International Campus, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Afr Health Sci. 2020 Mar;20(1):91-101. doi: 10.4314/ahs.v20i1.14.

DOI:10.4314/ahs.v20i1.14
PMID:33402897
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7750062/
Abstract

BACKGROUND

This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of Atazanavir/ritonavir over lopinavir/ritonavir in human immunodeficiency virus-1 (HIV-1) infection.

METHODS

Clinical trials with a head-to-head comparison of atazanavir/ritonavir and lopinavir/ritonavir in HIV-1 were included. Electronic databases: PubMed/Medline CENTRAL, Embase, Scopus, and Web of Science were searched. Viral suppression below 50 copies/ml at the longest follow-up period was the primary outcome measure. Grade 2-4 treatment-related adverse drug events, lipid profile changes and grade 3-4 bilirubin elevations were used as secondary outcome measures.

RESULTS

A total of nine articles from seven trials with 1938 HIV-1 patients were included in the current study. Atazanavir/ritonavir has 13% lower overall risk of failure to suppress the virus level < 50 copies/ml than lopinavir/ritonavir in fixed effect model (pooled RR: 0.87; CI: 0.78, 0.96; P=0.006). The overall risk of hyperbilirubinemia is very high for atazanavir/ritonavir than lopinavir/ritonavir in the random effects model (pooled RR: 45.03; CI: 16.03, 126.47; P< 0.0001).

CONCLUSION

Atazanavir/ritonavir has a better viral suppression at lower risk of lipid abnormality than lopinavir/ritonavir. The risk and development of hyperbilirubinemia from atazanavir-based regimens should be taken into consideration both at the time of prescribing and patient follow-up.

摘要

背景

本系统评价和荟萃分析旨在评估阿扎那韦/利托那韦相对于洛匹那韦/利托那韦在人类免疫缺陷病毒 1 型（HIV-1）感染中的安全性和有效性。

方法

纳入了头对头比较阿扎那韦/利托那韦和洛匹那韦/利托那韦在 HIV-1 中的临床试验。电子数据库：PubMed/Medline CENTRAL、Embase、Scopus 和 Web of Science 进行了检索。最长随访期间病毒抑制低于 50 拷贝/ml 是主要结局指标。2-4 级与治疗相关的不良药物事件、血脂谱变化和 3-4 级胆红素升高作为次要结局指标。

结果

本研究共纳入了来自 7 项试验的 9 篇文章，共有 1938 例 HIV-1 患者。在固定效应模型中，阿扎那韦/利托那韦的病毒抑制失败总体风险比洛匹那韦/利托那韦低 13%（合并 RR：0.87；CI：0.78，0.96；P=0.006）。在随机效应模型中，阿扎那韦/利托那韦的高胆红素血症总体风险远高于洛匹那韦/利托那韦（合并 RR：45.03；CI：16.03，126.47；P<0.0001）。

结论

阿扎那韦/利托那韦具有更好的病毒抑制作用，且发生脂质异常的风险较低。在开处方和患者随访时，都应考虑到基于阿扎那韦的方案的高胆红素血症的风险和发展。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/8736c7eba48e/AFHS2001-0091Fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/e79bd9617f03/AFHS2001-0091Fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/8b1e0d0ca38d/AFHS2001-0091Fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/12653c8b9962/AFHS2001-0091Fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/39c502b9d820/AFHS2001-0091Fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/ef9f0d48fb43/AFHS2001-0091Fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/829742fd96c7/AFHS2001-0091Fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/8736c7eba48e/AFHS2001-0091Fig7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/e79bd9617f03/AFHS2001-0091Fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/8b1e0d0ca38d/AFHS2001-0091Fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/12653c8b9962/AFHS2001-0091Fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/39c502b9d820/AFHS2001-0091Fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/ef9f0d48fb43/AFHS2001-0091Fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/829742fd96c7/AFHS2001-0091Fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2733/7750062/8736c7eba48e/AFHS2001-0091Fig7.jpg

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