PDF(Pubmed)
Abstract：
BACKGROUND: The use of integrase inhibitor-based antiretroviral therapy could be associated with worse weight and metabolic outcomes in patients with HIV infection.
METHODS: PubMed, EMBASE, and Scopus were searched from inception to March 2022. We selected randomized controlled trials (RCTs) comparing integrase inhibitors with other antiretroviral classes (efavirenz-based or protease inhibitor-based therapies) in naïve HIV patients. Random effects meta-analysis was used to assess the effects of integrase inhibitors vs. controls on weight and lipid outcomes. Effects were described as mean differences (MD) and their 95% confidence intervals (CI). Certain pieces of evidence (CoE) were evaluated using the GRADE methodology.
RESULTS: Six RCTs (n = 3521) were included, with patients followed up between 48 and 96 weeks. The use of integrase inhibitors in comparison with other antiretroviral classes was associated with an increase in weight (MD 2.15 kg, 95%CI 1.40 to 2.90, I2 = 0%, moderate CoE), and decreases in total cholesterol (MD -13.44 mg/dL, 95%CI -23.49 to -3.39, I2 = 96%, low CoE), LDL cholesterol (MD -1.37 mg/dL, 95%CI -19.24 to -3.50, I2 = 83%, low CoE), HDL cholesterol (MD -5.03 mg/dL, 95%CI -10.61 to 0.54, I2 = 95%, low CoE), and triglycerides (MD -20.70 mg/dL, 95%CI -37.25 to -4.15, I2 = 92%, low CoE). There was a high risk of bias in two RCTs and some concerns about bias in two RCTs.
CONCLUSIONS: In HIV patients, the use of integrase inhibitor-based therapy in comparison with protease inhibitor- or NNRTI-based therapy was associated with a small increase in weight and small decreases in lipid serum levels.
METHODS: PubMed, EMBASE, and Scopus were searched from inception to March 2022. We selected randomized controlled trials (RCTs) comparing integrase inhibitors with other antiretroviral classes (efavirenz-based or protease inhibitor-based therapies) in naïve HIV patients. Random effects meta-analysis was used to assess the effects of integrase inhibitors vs. controls on weight and lipid outcomes. Effects were described as mean differences (MD) and their 95% confidence intervals (CI). Certain pieces of evidence (CoE) were evaluated using the GRADE methodology.
RESULTS: Six RCTs (n = 3521) were included, with patients followed up between 48 and 96 weeks. The use of integrase inhibitors in comparison with other antiretroviral classes was associated with an increase in weight (MD 2.15 kg, 95%CI 1.40 to 2.90, I2 = 0%, moderate CoE), and decreases in total cholesterol (MD -13.44 mg/dL, 95%CI -23.49 to -3.39, I2 = 96%, low CoE), LDL cholesterol (MD -1.37 mg/dL, 95%CI -19.24 to -3.50, I2 = 83%, low CoE), HDL cholesterol (MD -5.03 mg/dL, 95%CI -10.61 to 0.54, I2 = 95%, low CoE), and triglycerides (MD -20.70 mg/dL, 95%CI -37.25 to -4.15, I2 = 92%, low CoE). There was a high risk of bias in two RCTs and some concerns about bias in two RCTs.
CONCLUSIONS: In HIV patients, the use of integrase inhibitor-based therapy in comparison with protease inhibitor- or NNRTI-based therapy was associated with a small increase in weight and small decreases in lipid serum levels.
摘要：
背景：使用基于整合酶抑制剂的抗逆转录病毒治疗可能与HIV感染患者的体重和代谢结果恶化有关。
方法：PubMed，EMBASE,和Scopus从开始到2022年3月进行了搜索。我们选择了在初治HIV患者中比较整合酶抑制剂与其他抗逆转录病毒疗法（基于依非韦仑或基于蛋白酶抑制剂的疗法）的随机对照试验（RCT）。随机效应荟萃分析用于评估整合酶抑制剂与控制体重和血脂结果。效果被描述为平均差(MD)和它们的95%置信区间(CI)。某些证据（CoE）使用GRADE方法进行了评估。
结果：包括六个RCT（n=3521），患者随访48至96周。与其他抗逆转录病毒类别相比，整合酶抑制剂的使用与体重增加有关（MD2.15kg，95CI1.40至2.90，I2=0%，中度CoE)，总胆固醇降低（MD-13.44mg/dL，95CI-23.49至-3.39，I2=96%，低CoE)，LDL胆固醇（MD-1.37mg/dL，95CI-19.24至-3.50，I2=83%，低CoE)，HDL胆固醇（MD-5.03mg/dL，95CI-10.61至0.54，I2=95%，低CoE)，和甘油三酯（MD-20.70mg/dL，95CI-37.25至-4.15，I2=92%，低CoE）。在两个RCT中存在较高的偏倚风险，并且在两个RCT中存在一些对偏倚的担忧。
结论：在HIV患者中，与基于蛋白酶抑制剂或NNRTI的治疗相比,基于整合酶抑制剂的治疗与体重小幅增加和血脂水平小幅下降相关.
方法：PubMed，EMBASE,和Scopus从开始到2022年3月进行了搜索。我们选择了在初治HIV患者中比较整合酶抑制剂与其他抗逆转录病毒疗法（基于依非韦仑或基于蛋白酶抑制剂的疗法）的随机对照试验（RCT）。随机效应荟萃分析用于评估整合酶抑制剂与控制体重和血脂结果。效果被描述为平均差(MD)和它们的95%置信区间(CI)。某些证据（CoE）使用GRADE方法进行了评估。
结果：包括六个RCT（n=3521），患者随访48至96周。与其他抗逆转录病毒类别相比，整合酶抑制剂的使用与体重增加有关（MD2.15kg，95CI1.40至2.90，I2=0%，中度CoE)，总胆固醇降低（MD-13.44mg/dL，95CI-23.49至-3.39，I2=96%，低CoE)，LDL胆固醇（MD-1.37mg/dL，95CI-19.24至-3.50，I2=83%，低CoE)，HDL胆固醇（MD-5.03mg/dL，95CI-10.61至0.54，I2=95%，低CoE)，和甘油三酯（MD-20.70mg/dL，95CI-37.25至-4.15，I2=92%，低CoE）。在两个RCT中存在较高的偏倚风险，并且在两个RCT中存在一些对偏倚的担忧。
结论：在HIV患者中，与基于蛋白酶抑制剂或NNRTI的治疗相比,基于整合酶抑制剂的治疗与体重小幅增加和血脂水平小幅下降相关.
