艾滋病毒感染者多重用药的患病率及全球趋势：一项系统评价与荟萃分析

Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis.

作者信息

Danjuma Mohammed I, Adegboye Oyelola A, Aboughalia Ahmed, Soliman Nada, Almishal Ruba, Abdul Haseeb, Mohamed Mohamad Faisal Hamad, Elshafie Mohamed Nabil, AlKhal Abdulatif, Elzouki Abdelnaser, Al-Saud Arwa, Chaponda Mas, Bidmos Mubarak Arriyo

机构信息

Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar College of Medicine, QU Health, Qatar University, Doha, Qatar.

Evolution Equations Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.

出版信息

Ther Adv Drug Saf. 2022 Aug 23;13:20420986221080795. doi: 10.1177/20420986221080795. eCollection 2022.

DOI:10.1177/20420986221080795

PMID:36052397

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9425890/

Abstract

BACKGROUND

There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients.

METHODS

We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper-Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using and statistics.

RESULTS

One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4-77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25-42%) ( = 100%, τ = 0.9170, < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27-63%) ( = 100%, τ = 1.0886, < 0.01) than Europe (29%, 95% CI: 20-40%) ( = 100%, τ = 0.7944, < 0.01).

CONCLUSION

The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies.

REGISTRATION

PLAIN LANGUAGE SUMMARY

In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors? In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America's compared with European cohorts of PLWH. Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.

摘要

背景

感染艾滋病毒者（PLWH）中多重用药的患病率呈上升趋势。然而，这些患者群体中多重用药的确切估计仍不确定。

方法

我们对PubMed、EMBASE、CROI、Cochrane系统评价数据库、科学引文索引和效果评价摘要数据库进行了系统检索，以查找2000年1月1日至2021年6月30日期间报告接受抗逆转录病毒治疗方案（ART）的PLWH中多重用药（摄入超过5种非抗逆转录病毒药物）患病率的研究。呈现了接受ART的HIV阳性患者中多重用药的患病率及Clopper-Pearson 95%置信区间。使用I²和τ统计量评估研究间的异质性。

结果

最初识别出197项研究，23项符合纳入标准，纳入了55988名PLWH，其中76.7%[95%置信区间（CI）：76.4 - 77.1]为男性。PLWH中多重用药的总体合并患病率为33%（95%CI：25 - 42%）（I² = 100%，τ = 0.9170，P < 0.0001）。美洲地区（44%，95%CI：27 - 63%）（I² = 100%，τ = 1.0886，P < 0.01）的多重用药患病率高于欧洲（29%，95%CI：20 - 40%）（I² = 100%，τ = 0.7944，P < 0.01）。

结论

本次综合分析得出的合并患病率估计表明，多重用药是PLWH中一个严重且日益严重的问题。可能显著减轻其影响的确切干预措施仍不确定，需要未来的前瞻性和系统性研究进行探索。

注册情况

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通俗易懂的总结

在感染艾滋病毒者（PLWH）中，多重用药的患病率是多少，它是否受社会人口统计学因素影响？在这项对23项研究（共55988名参与者）的系统评价和荟萃分析中，我们首次发现PLWH中多重用药的合并患病率估计为33%。与欧洲的PLWH队列相比，美洲地区的多重用药合并患病率相对较高。PLWH中的多重用药是一种不断上升的发病率，在政策和患者护理层面都需要紧急干预。