An updated systematic review of HIV-associated cryptococcal meningitis treatment strategies.
An updated systematic review of HIV-associated cryptococcal meningitis treatment strategies.
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HIV 相关隐球菌性脑膜炎治疗策略的最新系统评价。
DOI：
10.1111/hiv.13412
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发表时间：
2023
期刊：
影响因子：
3
通讯作者：
Rajasingham,Radha
中科院分区：
文献类型：
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作者：
Shapiro,AdrienneE;Tenforde,MarkW;Chiller,TomM;Ford,Nathan;Rajasingham,Radha
背景：本系统综述的目的是考虑到现有的最新证据，为治疗HIV相关隐球菌性脑膜炎的首选诱导疗法提供最新证据，以便为更新世卫组织指南的必要性提供信息。方法：我们通过PubMed、EMBASE、Cochrane图书馆和clinicaltrials.gov检索Medline，检索2018年7月9日（最后检索日期）至2021年9月1日期间评估首次发作HIV相关隐球菌脑膜炎诱导治疗的已发表或已完成的随机临床试验。结果一项纳入844例HIV相关隐球菌性脑膜炎患者的随机临床试验符合纳入标准。参与者随机分为两组：(1)两性霉素脱氧胆酸酯治疗7天，氟胞嘧啶和氟康唑作为对照；或(2)单剂量两性霉素脂质体10mg /kg联合氟胞嘧啶和氟康唑（干预）。在意向治疗分析中，单剂量两性霉素脂质体组的10周死亡率为24.8%[95%可信区间（CI）： 20.7-29.3%]，而对照组的10周死亡率为28.7% （95% CI: 24.4-33.4%）。10周死亡率的绝对差异为- 3.9%，单侧95% CI为1.2%，在10%预先指定的非劣效性范围内。与对照组相比，干预组出现3级和4级不良事件的参与者较少（50.0%对62.3%,p< 0.001）。结论：在本系统综述的单项研究中，单次高剂量两性霉素B脂质体联合氟胞嘧啶和氟康唑治疗HIV相关隐球菌性脑膜炎的疗效不低于世卫组织推荐的标准护理诱导治疗，不良事件显著减少。
BackgroundThe purpose of this systematic review is to provide updated evidence on the preferred induction therapy for the treatment of HIV‐associated cryptococcal meningitis considering the most recent evidence available in order to inform the need for updates to WHO guidelines.MethodsWe searched Medline via PubMed, EMBASE, the Cochrane Library and clinicaltrials.gov for published or completed randomized clinical trials that evaluated induction treatment of first episode HIV‐associated cryptococcal meningitis from 9 July 2018 (date of last search) to 1 September 2021.ResultsOne randomized clinical trial of 844 people with HIV‐associated cryptococcal meningitis met the inclusion criteria. Participants were randomized to: (1) amphotericin deoxycholate for 7 days, with flucytosine and fluconazole (control); or (2) a single dose of liposomal amphotericin 10 mg/kg with flucytosine and fluconazole (intervention).In the intention‐to‐treat analysis, 10‐week mortality was 24.8% [95% confidence interval (CI): 20.7–29.3%] in the single‐dose liposomal amphotericin group compared with 28.7% (95% CI: 24.4–33.4%) in the control group. The absolute difference in 10‐week mortality was −3.9% with an upper one‐sided 95% CI of 1.2%, within the 10% pre‐specified non‐inferiority margin. Fewer participants had grade 3 and 4 adverse events in the intervention arm compared with the control arm (50.0% vs. 62.3%,p< 0.001).ConclusionsIn the single study included in this systematic review, single high‐dose liposomal amphotericin B with flucytosine and fluconazole was non‐inferior to the WHO‐recommended standard of care induction therapy for HIV‐associated cryptococcal meningitis, with significantly fewer adverse events.