Benefits and risks of rapid initiation of antiretroviral therapy
Benefits and risks of rapid initiation of antiretroviral therapy
复制标题
DOI：
10.1097/qad.0000000000001671
复制
发表时间：
2018-01-02
期刊：
影响因子：
3.8
通讯作者：
Shubber, Zara
中科院分区：
文献类型：
--
作者：
Ford, Nathan;Migone, Chantal;Shubber, Zara
背景资料：最近的注意力集中在一旦确诊艾滋病毒，应多快开始抗逆转录病毒治疗（ART）的问题。我们评估了快速ART启动是否能改善患者预后。方法：我们检索了从开始到2017年8月的五个数据库。快速启动抗逆转录病毒治疗定义为在艾滋病毒诊断后14天内启动。结果：在随机试验中，同一天开始ART在12个月时增加了病毒抑制[三项试验：相对风险（RR）1.17，95%置信区间（CI）1.07-1.27]，12个月时继续护理（RR 1.11，95% CI 0.99-1.26），以及在90天内（4项试验：RR 1.35，95% CI 1.13-1.62）和确定合格性后12个月（3项试验：RR 1.17，95% CI 1.07-1.27）开始ART的可能性。死亡率降低（3项试验：RR 0.53，95% CI 0.24-1.08）以及12个月时失访减少（2项试验：RR 0.66，95% CI 0.42-1.04）的趋势不显著。在观察性研究中，提供加速抗逆转录病毒治疗启动导致3个月内开始抗逆转录病毒治疗的可能性更大（两项研究：RR 1.53，95% CI 1.11-2.10）。有一个趋势，在6个月（三项研究：RR 1.85，95%CI 0.96-3.55）失去后续行动的风险增加。结论：加速ART启动可以导致改善临床结果，并可能是特别有益的，在这些设置中，广泛的患者准备开始ART的结果在长时间的延迟。这些发现为世卫组织的一项建议提供了信息，该建议支持加速启动抗逆转录病毒治疗，包括当天开始抗逆转录病毒治疗。版权所有（C）2017作者。由Wolters Kluwer Health，Inc.出版。
Background: Recent attention has focused on the question of how quickly antiretroviral therapy (ART) should be started once HIV diagnosis is confirmed. We assessed whether rapid ART initiation improves patient outcomes.Methods: We searched five databases from inception up to August 2017. Rapid ART initiation was defined as initiation within 14 days of HIV diagnosis. Data were pooled using random effects meta-analysis.Results: Across the randomized trials, ART start on the same day increased viral suppression at 12 months [three trials: relative risk (RR) 1.17, 95% confidence interval (CI) 1.07-1.27], retention in care at 12 months (RR 1.11, 95% CI 0.99-1.26), and the likelihood of starting ART within 90 days (four trials: RR 1.35, 95% CI 1.13-1.62) and 12 months after eligibility was established (three trials: RR 1.17, 95% CI 1.07-1.27). There was a nonsignificant trend toward reduced mortality (three trials: RR 0.53, 95% CI 0.24-1.08), as well as reduced loss to follow-up at 12 months (2 trials: RR 0.66, 95% CI 0.42-1.04). In the observational studies, offering accelerated ART initiation resulted in a greater likelihood of having started ART within 3 months (two studies: RR 1.53, 95% CI 1.11-2.10). There was a trend toward an increased risk of being lost to follow-up at 6 months (three studies: RR 1.85, 95% CI 0.96-3.55).Conclusion: Accelerated ART initiation can lead to improved clinical outcomes and is likely to be of particular benefit in those settings where extensive patient preparation prior to starting ART results in long delays. These findings informed a WHO recommendation supporting accelerated ART initiation, including same day ART start. Copyright (C) 2017 The Author(s). Published by Wolters Kluwer Health, Inc.