The Effect of Successful Antiretroviral Therapy on Immune Activation and Reconstitution in HIV Infected Adults: A Systematic Review and Meta-Analysis.

IF 1.9 4区 医学 Q4 IMMUNOLOGY
Tawanda M Nyambuya, Phiwayinkosi V Dludla, Vuyolwethu Mxinwa, Bongani B Nkambule
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引用次数: 1

Abstract

We performed a systematic review and meta-analysis to investigate the impact of antiretroviral therapy (ART) on immune activation and reconstitution in people living with human immunodeficiency virus (PLWH). The PubMed electronic database and gray literature were searched from inception until March 2020. Studies were included if they reported the levels of immune activation and reconstitution at baseline and post-treatment. The random-effect model was used to calculate effect sizes. We included a total of ten studies comprising of 1 553 PLWH with an average age of 38.02 ± 10.10 years and a male/female ratio of 3.76. Pooled estimates showed a modest increase in the level of immune activation post-treatment (SMD: 0.64 [95% CI: -1.34, 2.63]; I2 = 98%, pH < 0.00001). In addition, treatment with ART significantly reconstituted the immune system (SMD: 0.70 [95% CI: 0.27, 1.44]; I2 = 68%, pH = 0.009). Notably, the level of immune reconstitution was independent of viral load or the treatment duration but dependent on the class of ARV drugs. Consequently, protease inhibitors were associated with the highest degree of immune restoration, followed by chemokine antagonists and lastly integrase inhibitors. In conclusion, immune activation persists in PLWH despite viral suppression and the degree of immune reconstitution is dependent on the drug class. Therefore, inclusion of protease inhibitors in ART may be of great benefit in immune restoration in patients with very low CD4 count.

成功的抗逆转录病毒治疗对HIV感染成人免疫激活和重建的影响:系统回顾和荟萃分析
我们进行了一项系统回顾和荟萃分析,以调查抗逆转录病毒治疗(ART)对人类免疫缺陷病毒(PLWH)感染者免疫激活和重建的影响。PubMed电子数据库和灰色文献从成立到2020年3月进行检索。如果研究报告了基线和治疗后的免疫激活和重建水平,则纳入研究。随机效应模型用于计算效应大小。我们共纳入10项研究,包括1553名PLWH,平均年龄38.02±10.10岁,男女比例为3.76。综合估计显示,治疗后免疫激活水平适度增加(SMD: 0.64 [95% CI: -1.34, 2.63];I2 = 98%, pH < 0.00001)。此外,ART治疗显著重建了免疫系统(SMD: 0.70 [95% CI: 0.27, 1.44];I2 = 68%, pH = 0.009)。值得注意的是,免疫重建水平与病毒载量或治疗时间无关,但取决于抗逆转录病毒药物的种类。因此,蛋白酶抑制剂与最高程度的免疫恢复相关,其次是趋化因子拮抗剂,最后是整合酶抑制剂。总之,尽管病毒受到抑制,但PLWH的免疫激活仍然存在,免疫重建的程度取决于药物类别。因此,在抗逆转录病毒治疗中加入蛋白酶抑制剂可能对CD4计数极低的患者的免疫恢复有很大的益处。
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来源期刊
AIDS reviews
AIDS reviews 医学-传染病学
CiteScore
3.40
自引率
4.50%
发文量
41
审稿时长
>12 weeks
期刊介绍: AIDS Reviews publishes papers reporting original scientific, clinical, epidemiologic and social research which contribute to the overall knowledge of the field of the acquired immunodeficiency syndrome and human retrovirology. Currently, the Journal publishes review articles (usually by invitation, but spontaneous submitted articles will also be considered). Manuscripts submitted to AIDS Reviews will be accepted on the understanding that the authors have not submitted the paper to another journal or published the material elsewhere.
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