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

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.