Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis.
Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis.
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DOI：
10.1186/s13643-020-01524-1
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发表时间：
2020-12-12
影响因子：
3.7
通讯作者：
Nyasulu PS
中科院分区：
文献类型：
--
作者：
Lailulo Y;Kitenge M;Jaffer S;Aluko O;Nyasulu PS
尽管获得抗逆转录病毒治疗（ART）的人数有所增加，但有关在资源匮乏的环境中接受艾滋病毒护理的艾滋病毒阳性者的治疗失败及其相关因素的数据有限。本综述旨在确定与资源匮乏环境中接受抗逆转录病毒治疗的艾滋病毒感染者抗逆转录病毒治疗失败相关的因素。我们对MEDLINE（PubMed）、Excerpta Medica数据库（EMBASE）、科克伦对照试验中心注册库（CENTRAL）、世界卫生组织（WHO）图书馆数据库以及拉丁美洲和加勒比健康科学文献（LILACS）进行了全面检索。我们纳入了观察性研究（队列研究、病例对照研究和横断面研究），其中青少年和成人艾滋病毒感染者接受抗逆转录病毒治疗，而不考虑ART方案。关注的主要结果是免疫学、病毒学和临床失败。一些次要结局是mm 3机会性感染、WHO临床分期和社会人口统计学因素。我们筛选了相关文章的标题、摘要和全文，一式两份。分歧以协商一致方式解决。我们通过荟萃分析来分析数据，以汇集每个感兴趣结果的结果。与治疗依从性良好的患者相比，治疗依从性差的患者中抗逆转录病毒治疗失败率高出近6倍（OR = 5.90，95% CI 3.50，9.94，中等证据强度）。与CD 4 ≥ 200 CD 4细胞/mm 3的患者相比，CD 4 < 200细胞/mm 3的患者治疗失败的可能性几乎高5倍（OR = 4.82，95% CI 2.44，9.52，证据强度低）。这一结果表明，在资源有限的情况下，粘附性差和CD 4计数低于200个细胞/mm 3与接受抗逆转录病毒治疗的艾滋病毒阳性患者的治疗失败显著相关。这篇综述强调了低CD 4计数和对ART的依从性差与ART治疗失败相关。卫生保健工作者和艾滋病毒项目实施者需要关注具有这些特征的患者，以防止ART治疗失败。该系统性综述方案已在国际系统性综述前瞻性注册中心（PROSPERO）注册，注册号：2019 CRD 42019136538。
Despite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among individuals living with HIV on ART in resource-poor settings. We conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, case-control, and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical failure. Some of the secondary outcomes were mm3 opportunistic infections, WHO clinical stage, and socio-demographic factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome of interest. Antiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/mm3 compared to those with CD4 ≥ 200 CD4 cells/mm3 (OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence). This result shows that poor adherence and CD4 count below < 200 cells/mm3 are significantly associated with treatment failure among HIV-positive patients on ART in a resource-limited setting. This review highlights that low CD4 counts and poor adherence to ART were associated to ART treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who have these characteristics in order to prevent ART treatment failure. The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: 2019 CRD42019136538.
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影响因子：
3.7
作者：
Babo, Yohannes Demissie;Alemie, Getahun Asres;Fentaye, Fasil Walelign
通讯作者：
Fentaye, Fasil Walelign
影响因子：
2.2
作者：
Hassan AS;Nabwera HM;Mwaringa SM;Obonyo CA;Sanders EJ;Rinke de Wit TF;Cane PA;Berkley JA
通讯作者：
Berkley JA
DOI：
10.1097/qai.0b013e3181820141
发表时间：
2008-09-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Bisson GP;Rowh A;Weinstein R;Gaolathe T;Frank I;Gross R
通讯作者：
Gross R
影响因子：
105.7
作者：
Higgins, JPT;Thompson, SG;Altman, DG
通讯作者：
Altman, DG
影响因子：
3.7
作者：
El-Khatib Z;Katzenstein D;Marrone G;Laher F;Mohapi L;Petzold M;Morris L;Ekström AM
通讯作者：
Ekström AM