Efavirenz-Based Regimens in Antiretroviral-Naive HIV-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Efavirenz-Based Regimens in Antiretroviral-Naive HIV-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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DOI：
10.1371/journal.pone.0124279
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Pilc A
中科院分区：
文献类型：
--
作者：
Kryst J;Kawalec P;Pilc A
依法韦仑是一种非核苷类逆转录酶抑制剂（NNRTI），是最常用的抗逆转录病毒药物之一。本文提供了一个系统的概述和荟萃分析的临床试验比较依法韦仑和其他活性药物目前推荐用于治疗艾滋病毒感染，抗逆转录病毒初治患者。检索了截至2013年12月23日的电子数据库（Pubmed、Embase、科克伦图书馆、Trip数据库），以查找以同行评审论文形式发表的随机对照临床试验，以及关于将基于依法韦仑的方案用作HIV感染的初始治疗的随机对照临床试验。34项研究纳入系统评价，26项试验适合进行荟萃分析。将依法韦仑与四种不同类别的药物进行比较：依法韦仑以外的非核苷类逆转录酶抑制剂（奈韦拉平或利匹韦林）、整合酶链转移抑制剂（InSTI）、利托那韦增强蛋白酶抑制剂（bPI）和趋化因子（C-C基序）受体5（CCR 5）拮抗剂（马拉韦罗），所有这些药物均加入背景方案。目前的荟萃分析结果显示，在疗效结局（疾病进展和/或死亡，血浆病毒HIV RNA <50拷贝/ml）方面，基于依法韦仑的方案与基于NNRTI、利托那韦增强的PI或CCR 5拮抗剂的其他推荐方案同样有效，而在第48周时，接受InSTI治疗的患者中有统计学显著性更多患者达到血浆病毒载量<50拷贝/ml。与基于InSTI和基于CCR 5的治疗相比，基于依法韦仑的治疗与因不良事件而停止治疗的风险更高相关。然而，基于依非韦伦的治疗与基于InSTI和基于CCR 5的治疗的比较是基于有限数量的试验，因此，这两种比较的结论必须在进一步可靠的随机对照研究中得到证实。我们的荟萃分析结果支持目前的抗逆转录病毒初治的HIV感染患者的临床指南，其中依法韦仑是分析人群中最首选的治疗方案之一。基于InSTI和CCR 5的治疗相对于基于依法韦仑的治疗的有益安全性特征需要进一步研究。
Efavirenz, a non-nucleoside reverse-transcriptase inhibitor (NNRTI) is one of the most commonly prescribed antiretroviral drugs. The present article provides a systematic overview and meta-analysis of clinical trials comparing efavirenz and other active drugs currently recommended for treatment of HIV-infected, antiretroviral-naive patients. Electronic databases (Pubmed, Embase, the Cochrane Library, Trip Database) were searched up till 23 December 2013 for randomized controlled clinical trials published as a peer-reviewed papers, and concerning efavirenz-based regimens used as initial treatment for HIV infection. Thirty-four studies were included in the systematic review, while twenty-six trials were suitable for the meta-analysis. Efavirenz was compared with drugs from four different classes: NNRTIs other than efavirenz (nevirapine or rilpivirine), integrase strand transfer inhibitors (InSTIs), ritonavir-boosted protease inhibitors (bPI) and chemokine (C-C motif) receptor 5 (CCR5) antagonists (maraviroc), all of them were added to the background regimen. Results of the current meta-analysis showed that efavirenz-based regimens were equally effective as other recommended regimens based on NNRTI, ritonavir-boosted PI or CCR5 antagonist in terms of efficacy outcomes (disease progression and/or death, plasma viral HIV RNA <50 copies/ml) while statistically significant more patients treated with InSTI achieved plasma viral load <50 copies/ml at week 48. In comparison with both InSTI-based and CCR5-based therapy, efavirenz-based treatment was associated with a higher risk of therapy discontinuation due to adverse events. However, comparisons of efevirenz-based treatment with InSTI-based and CCR5-based therapy were based on a limited number of trials, therefore, conclusions from these two comparisons must be confirmed in further reliable randomized controlled studies. Results of our meta-analysis support the present clinical guidelines for antiretroviral-naive, HIV-infected patients, in which efavirenz is one of the most preferred regimens in the analyzed population. Beneficial safety profile of InSTI-based and CCR5-based therapy over efavirenz-based treatment needs further studies.
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