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Abstract：
Integrase strand transfer inhibitors (InSTIs) decrease HIV plasma viral load faster than other antiretroviral classes. More rapid viral load decline has been associated with higher risk of immune reconstitution inflammatory syndrome (IRIS). There are conflicting reports on the association between InSTI and IRIS. We performed a systematic review and meta-analysis to compare the risk of IRIS among treatment-naive HIV-positive patients starting InSTI versus non-InSTI regimens.
We searched PubMed, Scopus, Web of Science, Africa-Wide, and Cochrane databases from earliest available date to 26 November 2021, for randomized controlled trials (RCTs) having intervention arms with InSTI versus control arms without InSTI in patients initiating first-line antiretroviral therapy. The primary outcome was relative risk (RR) of IRIS, whereas the secondary outcome was RR of paradoxical tuberculosis-associated IRIS (TB-IRIS). Data were combined by random-effects meta-analysis according to the Mantel-Haenszel method. The protocol for this study is registered with PROSPERO, CRD42020213976.
We included 14 RCTs comprising 8696 participants from 6 continents for the primary outcome of IRIS and a subset of 674 participants (from 3 RCTs) for the secondary outcome of paradoxical TB-IRIS. Risk of IRIS was similar between InSTI and non-InSTI regimens (RR, 0.93; 95% confidence interval: 0.75 to 1.14). There was a trend towards a lower risk of paradoxical TB-IRIS with InSTI versus efavirenz regimens that was not statistically significant (RR, 0.64; 95% confidence interval: 0.34 to 1.19).
In this meta-analysis among treatment-naive patients commencing first-line antiretroviral therapy, InSTI regimens were not associated with higher risk of IRIS.
We searched PubMed, Scopus, Web of Science, Africa-Wide, and Cochrane databases from earliest available date to 26 November 2021, for randomized controlled trials (RCTs) having intervention arms with InSTI versus control arms without InSTI in patients initiating first-line antiretroviral therapy. The primary outcome was relative risk (RR) of IRIS, whereas the secondary outcome was RR of paradoxical tuberculosis-associated IRIS (TB-IRIS). Data were combined by random-effects meta-analysis according to the Mantel-Haenszel method. The protocol for this study is registered with PROSPERO, CRD42020213976.
We included 14 RCTs comprising 8696 participants from 6 continents for the primary outcome of IRIS and a subset of 674 participants (from 3 RCTs) for the secondary outcome of paradoxical TB-IRIS. Risk of IRIS was similar between InSTI and non-InSTI regimens (RR, 0.93; 95% confidence interval: 0.75 to 1.14). There was a trend towards a lower risk of paradoxical TB-IRIS with InSTI versus efavirenz regimens that was not statistically significant (RR, 0.64; 95% confidence interval: 0.34 to 1.19).
In this meta-analysis among treatment-naive patients commencing first-line antiretroviral therapy, InSTI regimens were not associated with higher risk of IRIS.
摘要：
整合酶链转移抑制剂（InSTIs）比其他抗逆转录病毒类别更快地降低HIV血浆病毒载量。更快速的病毒载量下降与免疫重建炎症综合征（IRIS）的高风险相关。关于InSTI和IRIS之间的关联有冲突的报告。我们进行了系统评价和荟萃分析，以比较开始InSTI和非InSTI方案的未接受治疗的HIV阳性患者的IRIS风险。
我们搜索了PubMed,Scopus,WebofScience,非洲范围,和Cochrane数据库，从最早的可用日期到2021年11月26日，用于在开始一线抗逆转录病毒治疗的患者中使用InSTI干预组与不使用InSTI的对照组的随机对照试验（RCT）。主要结果是IRIS的相对风险（RR），而次要结局是反常结核相关性IRIS(TB-IRIS)的RR.根据Mantel-Haenszel方法通过随机效应荟萃分析合并数据。这项研究的方案在PROSPERO注册，CRD42020213976。
我们纳入了14个RCT，包括来自6大洲的8696名参与者，用于IRIS的主要结局，以及674名参与者的子集（来自3个RCT）用于矛盾的TB-IRIS的次要结局。InSTI和非InSTI方案的IRIS风险相似(RR，0.93；95%置信区间：0.75~1.14）。InSTI与efavirenz方案相比，有一种趋势是降低了矛盾的TB-IRIS的风险，这在统计学上没有显着意义（RR，0.64；95%置信区间：0.34~1.19）。
在这项对开始一线抗逆转录病毒治疗的未接受治疗的患者进行的荟萃分析中，InSTI方案与较高的IRIS风险无关。
我们搜索了PubMed,Scopus,WebofScience,非洲范围,和Cochrane数据库，从最早的可用日期到2021年11月26日，用于在开始一线抗逆转录病毒治疗的患者中使用InSTI干预组与不使用InSTI的对照组的随机对照试验（RCT）。主要结果是IRIS的相对风险（RR），而次要结局是反常结核相关性IRIS(TB-IRIS)的RR.根据Mantel-Haenszel方法通过随机效应荟萃分析合并数据。这项研究的方案在PROSPERO注册，CRD42020213976。
我们纳入了14个RCT，包括来自6大洲的8696名参与者，用于IRIS的主要结局，以及674名参与者的子集（来自3个RCT）用于矛盾的TB-IRIS的次要结局。InSTI和非InSTI方案的IRIS风险相似(RR，0.93；95%置信区间：0.75~1.14）。InSTI与efavirenz方案相比，有一种趋势是降低了矛盾的TB-IRIS的风险，这在统计学上没有显着意义（RR，0.64；95%置信区间：0.34~1.19）。
在这项对开始一线抗逆转录病毒治疗的未接受治疗的患者进行的荟萃分析中，InSTI方案与较高的IRIS风险无关。
