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Review
. 2022 Mar 4:13:811357.
doi: 10.3389/fphar.2022.811357. eCollection 2022.

Effectiveness and Safety Analysis of PIs/r Based Dual Therapy in Treatment-Naïve, HIV/AIDS Patients: A Network Meta Analysis of Randomized Controlled Trials

Liu Hui  1 , Han Xiaoxu  1 , Wang Yuqi  1 , Wang Peng  1 , Wang Xin  1 , Yi Yunyun  1 , Li Xin  1
Affiliations
Review

Effectiveness and Safety Analysis of PIs/r Based Dual Therapy in Treatment-Naïve, HIV/AIDS Patients: A Network Meta Analysis of Randomized Controlled Trials

Liu Hui et al. Front Pharmacol. .

Abstract

Background: Dual anti-retroviral therapy is the main proven valuable intervention type for treating naïve HIV/AIDS. Currently, no high-quality evidence is available regarding the best dual schemes. Objectives: The aim of this study is to evaluate the effectiveness and safety of PIs/r-based dual therapy in treatment-naïve HIV/AIDS patients by using network meta-analysis. Methods: Randomized controlled trials of PIs/r-based dual therapy in treatment-naïve HIV/AIDS were searched based on Embase, PubMed and Cochrane library database from January 2006 to June 2021. Taking viral suppression rate, CD4+T cell count changes from baseline as the primary indicator and adverse events rate as secondary indicator, the network meta-analysis was performed on Review Manager and STATA software. Heterogeneity was assessed by the Q statistic and I2. We registered our protocol in Prospero with ID CRD42021275466. Results: Among 15 randomized controlled trials (3,497 patients and 7 PIs/r-based dual therapy) were reviewed in this study. According to the forest map, DRV/r + INSTIs was more effective compared to triple therapy (TT) in viral suppression [OR 0.82, 95% CI (0.61-1.11)], in CD4+T cell count changes from baseline [MD 1.9, 95% CI (0.7, 3.1), I 2 86%], in adverse events [OR 0.98, 95% CI (0.68-1.39)]. Furthermore, SUCRA ranking analysis indicated that DRV/r + INSTIs was superior to TT in viral suppression (DRV/r + INSTIs 75.5% > TT 41.2%) and in immune construction (DRV/r + INSTIs 67% > TT 42%). In addition, DRV/r + INSTIs was similar to TT in adverse events (DRV/r + INSTIs 54.9% ≈ TT 54.7%). Conclusion: DRV/r + INSTIs was obviously superior to TT in viral suppression and immune reconstruction, and was not higher than TT in adverse events. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021275466.

Keywords: HIV infection; PIs/r; aids; dual therapy; network meta-analysis; triple therapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart of study selection.
FIGURE 2
FIGURE 2
Risk of bias assesment summary.
FIGURE 3
FIGURE 3
The results of network meta-analysis with viral suppression rate. (A) The network diagram. (B) The comparison-correction funnel diagram (A: LPV/r + PIs, B: LPV/r + NRTIs, C: LPV/r + INSTIs, D: LPV/r + NNRTIs, E: DRV/r + INSTIs, F: TT). (C): SUCRA value ranking chart.
FIGURE 4
FIGURE 4
Node-splitting of network meta-analysis based on viral suppression.
FIGURE 5
FIGURE 5
Cluster diagram among different outcome indicators.
See this image and copyright information in PMC

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