Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.
School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
BMC Infect Dis. 2024 Feb 2;24(1):160. doi: 10.1186/s12879-024-09050-4.
The pathological consequences of inflammation persist in people living with the human immunodeficiency virus (PLWH), regardless of the positive outcomes of highly active antiretroviral therapy (HAART). The current systematic review and meta-analysis aims to understand and explore the levels of high-sensitivity C-reactive protein (hs-CRP) and other cardiovascular disease (CVD)-risk factors including lipid profiles among PLWH on HAART. Major electronic databases including PubMed, Scopus, and Web of Science were searched to retrieve relevant global literature reporting on hs-CRP levels in PLWH on HAART. A total of twenty-two studies with an average participant age of 40 years were eligible for this systematic review and meta-analysis. Majority of the included studies were from Africa (n = 11), the United States (n = 6), and Europe (n = 5). Our systemic review showed that most studies reported increased levels of hs-CRP among PLWH on HAART when compared to controls (PLWH not on HAART or those without HIV), especially in studies from Africa. This was supported by a meta-analysis showing significantly elevated levels of hs-CRP in PLWH on HAART when compared to PLWH not on HAART (standardised mean difference [SMD] = 0.56; 95% CI = 0.10‑1.01, z = 2.41; p = 0.02) or those without HIV (SMD = 1.19; 95% CI = 0.76‑1.63, z = 5.35; p < 0.001). Where lipid profiles, as a major predictor for CVD risk, were also impaired in PLWH on HAART when compared to PLWH not on HAART and HIV-negative participants. In conclusion, elevated levels of hs-CRP and lipid levels are prevalent in PLWH on HAART, this may increase the risk of CVD complications, especially for those people living in Africa. However, more evidence in larger population studies is required to confirm these outcomes and unveil any possible clinical implications of HAART-induced modulation of hs-CRP levels in PLWH.
炎症的病理后果在接受高效抗逆转录病毒治疗 (HAART) 的人类免疫缺陷病毒 (PLWH) 感染者中持续存在,而不管 HAART 是否取得积极效果。本系统评价和荟萃分析旨在了解和探讨接受 HAART 的 PLWH 中高敏 C 反应蛋白 (hs-CRP) 及其他心血管疾病 (CVD) 风险因素(包括血脂谱)的水平。主要电子数据库(包括 PubMed、Scopus 和 Web of Science)检索了有关接受 HAART 的 PLWH 中 hs-CRP 水平的全球文献。共有 22 项研究符合本系统评价和荟萃分析的条件,平均参与者年龄为 40 岁。纳入的研究大多来自非洲(n=11)、美国(n=6)和欧洲(n=5)。我们的系统综述表明,与对照组(未接受 HAART 的 PLWH 或无 HIV 感染者)相比,大多数研究报告接受 HAART 的 PLWH 的 hs-CRP 水平升高,特别是来自非洲的研究。荟萃分析也支持这一结果,与未接受 HAART 的 PLWH(标准化均数差 [SMD] = 0.56;95%置信区间 [CI] = 0.10-1.01,z = 2.41;p = 0.02)或无 HIV 感染者(SMD = 1.19;95%CI = 0.76-1.63,z = 5.35;p<0.001)相比,接受 HAART 的 PLWH 的 hs-CRP 水平显著升高。此外,与未接受 HAART 的 PLWH 和无 HIV 感染者相比,接受 HAART 的 PLWH 的血脂谱(CVD 风险的主要预测因子)也受损。总之,接受 HAART 的 PLWH 中 hs-CRP 和血脂水平升高较为普遍,这可能会增加 CVD 并发症的风险,尤其是在非洲生活的人群。然而,需要更多的大型人群研究证据来证实这些结果,并揭示 HAART 诱导 PLWH 中 hs-CRP 水平变化的任何可能的临床意义。