基线CD_(4)^(+)T细胞数和病毒载量对整合酶抑制剂方案疗效影响的Meta分析

Effect of baseline CD_(4)^(+)T lymphocyte counts and HIV viral load on the efficacy of integrase inhibitor-based regimens:a meta-analysis

目的评价HIV感染者基线CD4+T淋巴细胞(CD4细胞)计数和病毒载量对含整合酶抑制剂治疗方案疗效的影响。方法检索知网、万方、维普、PubMed以及Web of Science数据库,对符合纳入标准文献进行质量评价和原始数据提取,对基线CD4细胞计数(<200/μL vs.≥200/μL)和HIV病毒载量(>10^(5)拷贝/mL vs.≤10^(5)拷贝/mL)进行亚组分析,评估各亚组治疗失败风险,采用R软件进行Meta分析。结果共纳入29篇文献。Meta分析结果显示,与基线CD4细胞计数≥200/μL组相比,<200/μL组治疗48周(OR=1.93,95%Cl:1.47~2.53,P=0.01)和96周(OR=1.53,95%Cl:1.13~2.09,P<0.01)的治疗失败风险更高;与基线病毒载量≤10^(5)拷贝/mL的HIV感染者相比,>10^(5)拷贝/mL的HIV感染者治疗48周后治疗失败风险更高(OR=1.82,95%Cl:1.37~2.42,P<0.01)。结论HIV感染者基线CD4细胞计数和病毒载量是影响含整合酶抑制剂治疗方案疗效的重要因素,应积极推行“发现即治疗”政策,促进HIV感染者的早检测、早诊断及早治疗。

Objective To examine the effect of baseline CD_(4)^(+)T lymphocyte(CD4 cell)counts and HIV viral load on the efficacy of integrase inhibitor-based regimens among HIV-infected individuals.Methods Publications pertaining to the effect of baseline CD4 cell counts and HIV viral load on the efficacy of integrase inhibitor-based regimens among HIV-infected individuals were retrieved in national and international electronic databases,including CNKI,Wanfang Data,VIP,PubMed and Web of Science.The quality of publications that met the inclusion criteria was evaluated and all original data were extracted from included publications.Subgroup analyses were performed to compare the failure in treatment with integrase inhibitor-based regimens between HIV-infected individuals with baseline CD4 cell counts of<200 cells/μL and those with baseline CD4 cell counts of 200 cells/μL and greater,and between HIV-infected individuals with HIV viral load of>10^(5)copies/mL and those with viral load of 10^(5)copies/mL and lower.All meta-analyses were performed with R package.Results A total of 29 eligible publications were included.Meta-analysis showed a higher risk of treatment failure among HIV-infected individuals with baseline CD4 cell counts of<200 cells/μL and receiving integrase inhibitor-based regimens for 48[odds ratio(OR)=1.93,95%confidential interval(CI):(1.47,2.54),P=0.01]and 96 weeks[OR=1.53,95%CI:(1.13,2.09),P<0.01]than among those with baseline CD4 cell counts of 200 cells/μL and greater,and a higher risk of treatment failure among HIV-infected individuals with baseline HIV viral load of>10^(5)copies/mL and receiving integrase inhibitor-based regimens for 48 weeks than among those with baseline HIV viral load of 10^(5)copies/mL and lower[OR=1.82,95%CI:(1.37,2.42),P<0.01].Conclusions Baseline CD4 cell counts and HIV viral load are important factors affecting the response to integrase inhibitor-based regimens.The“immediate antiretroviral therapy”policy is strongly recommended to facilitate early identification,early diagnosis and early treatment of HIV-infected individuals.