HIV感染者接受早期抗病毒治疗改善预后的Meta分析

Meta-analysis of the improvement of prognosis in HIV-infected patients receiving early antiviral therapy

目的系统评估影响HIV感染者接受早期抗病毒治疗对远期预后的影响。方法检索pubmed、Web of Science、知网、万方、中国生物医药文献数据库2010年1月-2022年6月的文献,参考Cochrane文档标准评估文献质量,应用RevMan5.3软件分析数据。结果两项比较死亡率的研究无异质性,初期抗病毒治疗有效降低了患者死亡率;两项研究对比免疫重建效果显示明显异质性,早期抗病毒治疗患者的免疫功能恢复更迅速;两项研究比较抑制病毒的效果具较高异质性,早期应用抗病毒药患者获得病毒抑制的几率更大;四项研究对比病毒学失败无异质性,早期抗病毒治疗的患者较少发生病毒学失败。结论HIV感染者接受早期抗病毒治疗可降低死亡风险和病毒学失败风险,更易出现病毒学抑制和更早重建免疫功能。无论CD4计数如何,早期诊断并启动抗逆转录病毒的治疗十分必要。

Objective To evaluate the long-term effects of early antiviral therapy on the prognosis of HIV-infected patients.Methods pubmed,Web of Science,CNKI,Wanfang,and China BioMedicine Literature Database were searched for literature from January 2010 to June 2022.The quality of the literature was evaluated according to Cochrane document standards,and data were analyzed using RevMan5.3 software.Results Two studies comparing mortality had no heterogeneity,and early antiviral therapy effectively reduced patient mortality.Two studies comparing immune reconstruction showed significant heterogeneity,and patients receiving early antiviral therapy had a more rapid recovery of immune function.Two studies comparing viral suppression had high heterogeneity,and patients receiving early antiviral therapy had a greater chance of achieving viral suppression.Four studies comparing virologic failure had no heterogeneity,and patients receiving early antiviral therapy had less virologic failure.Conclusions Early antiviral therapy for HIV-infected patients can reduce the risk of death and virologic failure,and is more likely to achieve viral suppression and earlier immune function reconstruction.Early diagnosis and initiation of antiretroviral therapy are necessary regardless of CD4 count.