早期抗病毒治疗对于改善HIV感染者预后的Meta分析  

Early antiretroviral therapy for improving the prognosis of HIV-infected patients:a meta-analysis

作　　者：王达 张洋 宋爱心 李爱新 高美霞 江水[1] 张彤 吴昊[2,3] 陈官芝 黄晓婕[2] WANG Da;ZHANG Yang;SONG Aixin;LI Aixin;GAO Meixia;JIANG Shui;ZHANG Tong;WU Hao;CHEN Guanzhi;HUANG Xiaojie(The Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China;CenteRfoRInfectious Disease,Beijing Youan Hospital,Capital Medical University,Beijing 100069;Beijing Key Laboratory of HIV/AIDS Research,Beijing Youan Hospital,Capital Medical University,Beijing 100069)

机构地区：[1]青岛大学附属医院,山东青岛266003 [2]首都医科大学附属北京佑安医院感染中心,北京100069 [3]首都医科大学附属北京佑安医院艾滋病研究北京市重点实验室,北京100069

出　　处：《中国艾滋病性病》2021年第2期121-126,共6页Chinese Journal of Aids & STD

基　　金：国家自然科学基金青年科学基金(81901089);国家自然科学基金项目(81701984);中国博士后科学基金面上资助(2019M660718);国家科技重大专项(2017ZX10201101,2017ZX10202101);北京市科技项目(D161100000416003);北京市博士后科学基金国际交流培养资助派出项目(2019PC-11);艾滋病研究北京市重点实验室(BZ0089);艾滋病研究北京市重点实验室开放课题(BJYAHKF2019001);北京优秀人才计划(2018000021223ZK04)。

摘　　要：目的为给临床工作者提供艾滋病抗病毒治疗(ART)指南的决策依据,系统地查阅相关文献,以评估CD4^(+)T淋巴细胞(简称CD4细胞)≥500个/mm^(3)(早期治疗)与<500个/mm^(3)(延迟治疗)的艾滋病病毒(HIV)感染者之间临床疗效的差异。方法在PubMed、Web of Science、EMBASE内系统地检索2000年1月1日至2019年12月1日期间发表的相关英文文章。汇总纳入研究数据,采用ReviewManager 5.3对效应量进行Meta分析。结果最终确定了17篇研究,其中能够进一步分析在CD4细胞<350个/mm^(3)启动ART的文献有13篇。12项研究中死亡的合并相对危险度(RR)为0.83,95%的可信区间(CI):0.75~0.92,6项研究评估艾滋病进展风险(RR=0.87,95%CI:0.82~0.93),由于定义不同,2项研究评估免疫重建(RR=1.58,95%CI:0.70~3.55),5项研究评估病毒学反应,其中2项研究分析病毒抑制(RR=1.04,95%CI:0.99~1.08),3项研究分析病毒学失败(RR=0.76,95%CI:0.56~1.02);3项研究评估耐药的风险(RR=0.77,95%CI:0.60~0.97),2项研究评估失访风险(RR=0.92,95%CI:0.81~1.04)。对CD4细胞<350个/mm^(3)进行分层分析,早期治疗的优势更加明显。结论在感染HIV的成年患者中,早期启动ART可改善患者健康状况,是一种经济有效的治疗策略。Objective To provide a basis for decision making of clinical practitioners about the guidelines for antiretroviral therapy(ART),and systematically evaluate the difference in clinical efficacy between HIVinfected patients with CD4^(+)>500/mm^(3)and CD4^(+)<500/mm^(3).Methods The databases were searched including Pub Med,Web of Science,EMBASE to collect English articles published from January 1 st,2000 to December 1 st,2019 h.Meta-analysis was performed on the literature by ReviewManager5.3 after data were extracted.Results 17 studies were selected,and 13 papers could be used for further analysis of clinical efficacy with initiation of ART in CD4^(+)<350/mm^(3).The pooled risk ratio(RR)of mortality of 12 studies was 0.83,95%confidence interval(CI)was 0.75-0.92.The pooled RR for progression to AIDS from 6 studies was 0.87(95%CI 0.82-0.93).The pooled RR for immunologic recovery for 2 studies was 1.58(95%CI 0.70-3.55).The pooled RR of viral suppression from two studies was 1.04(95%CI 0.99-1.08).The pooled RR of viral failure from three studies was 0.76(95%CI 0.56-1.02).The pooled RR of drug resistance from two articles was 0.77(95%CI 0.60-0.97),and the pooled RR of loss to follow-up from two articles was 0.92(95%CI 0.81-1.04).Stratified analysis of CD4^(+)<350/mm^(3)showed more obvious advantages in early treatment.Conclusion Early initiation of ART can improves the health of HIV-infected adults and is a cost-effective treatment strategy.

关 键 词：艾滋病病毒 抗病毒治疗 CD4^(+)T淋巴细胞 早期/延迟治疗 META分析 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]