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    含蛋白酶抑制剂的双重治疗对初治艾滋病的疗效和安全性的网状meta分析

    Effectiveness and Safety of Protease Inhibitors Based on Dual Therapy in AIDS-naïve patients: A Network Meta Analysis

      摘要
    • 摘要:
      目的 系统评价以蛋白酶抑制剂(protease inhibitors，PIs)为基础的双重治疗在初治艾滋病患者中的疗效及安全性。
      方法 计算机检索PubMed、Embase、Cochrane Library数据库，检索关于以PIs为基础的双重治疗初治艾滋病患者的随机对照试验(randomized controlled trial，RCT)，检索时限均为建库至2023年5月。采用Cochrane推荐的偏倚风险评估工具对纳入RCT进行质量评价。应用RevMan 5.4、Stata 14、ADDIS软件进行贝叶斯网状meta分析。
      结果 纳入15篇RCT，总样本量3 407例，纳入8种干预措施。在HIV病毒抑制率方面，排序为洛匹那韦/利托那韦(lopinavir/ritonavir，LPV/r)+核苷类反转录酶抑制剂(nucleoside/nucleotide reverse transcripates inhibitors，NRTIs)>传统三药治疗(triple therapy，TT)>达芦那韦/考比司他(darunavir/cobicistat，DRV/r)+整合酶链转移抑制剂(integrase strand transferinhibitors，INSTIs)>LPV/r+INSTIs>DRV/r+ C-C趋化因子受体5(C-C chemokine receptor type 5，CCR5)>LPV/r+PIs>LPV/r+CCR5>LPV/r+NNRTIs。不良反应事件发生率方面，排序为LPV/r+CCR5>LPV/r+ PIs>DRV/r+INSTIs>TT>LPV/r+INSTIs>LPV/r+NRTIs>DRV/r+CCR5。在CD4+T淋巴细胞较基线的变化值方面，排序为LPV/r+CCR5>LPV/r+NRTIs>TT>DRV/r+INSTIs>LPV/r+PIs>LPV/r+NNRTIs。
      结论 根据本研究结果，以PIs为基础的双重治疗方案可作为初治艾滋病患者的简化治疗方案。其中，LPV/r+NRTIs和DRV/r+INSTIs的双重治疗方案可显著抑制HIV病毒和修复免疫重建，且安全性好，有望替代传统的TT方案。

       

      Abstract:
      OBJUECTVE To systematically evaluate the efficacy and safety of protease inhibitors(PIs) based dual therapy in AIDS-naïve patients.
      METHODS PubMed, Embase, Cochrane Library databases were electronically retrieved to gather randomized controlled trial(RCT) of PIs based dual therapy in AIDS-naïve patients from their inception to May, 2023. The quality of included RCT wans evaluated using a Cochrane recommended bias risk assessment tool. Bayesian network meta-analysis was performed by RevMan 5.4, Stata 14 and ADDIS.
      RESULTS Fifteen RCTs with a sample size of 3407 were included, including 8 interventions. The order of viral suppression rate was LPV/r+NRTIs>TT>DRV/r+INSTIs>LPV/r+INSTIs>DRV/r+CCR5>LPV/r+PIs>LPV/r+CCR5>LPV/r+NNRTIs, the order of adverse events rate was LPV/r+CCR5>LPV/r+PIs>DRV/r+INSTIs>TT>LPV/r+INSTIs>LPV/r+NRTIs>DRV/r+CCR5, the order of CD4+T cell count changes from baseline was LPV/r+CCR5>LPV/r+NRTIs>TT>DRV/r+INSTIs>LPV/r+PIs>LPV/r+NNRTIs.
      CONCLUSION According to the results of this study, PIs based dual therapy can be used as a simplified treatment regimen for AIDS-naïve patients. Among them, the dual therapy regimen of LPV/r+NRTIs and DRV/r+INSTIs can suppress HIV virus and repair immune reconstruction with good safety, which is expected to replace the traditional three-drugs therapy regimen.

       

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