PMID- 35175970
OWN - NLM
STAT- MEDLINE
DCOM- 20220617
LR  - 20240214
IS  - 1944-7884 (Electronic)
IS  - 1525-4135 (Print)
IS  - 1525-4135 (Linking)
VI  - 90
IP  - 2
DP  - 2022 Jun 1
TI  - Risk of Immune Reconstitution Inflammatory Syndrome With Integrase Inhibitors 
      Versus Other Classes of Antiretrovirals: A Systematic Review and Meta-analysis of 
      Randomized Trials.
PG  - 232-239
LID - 10.1097/QAI.0000000000002937 [doi]
AB  - BACKGROUND: Integrase strand transfer inhibitors (InSTIs) decrease HIV plasma 
      viral load faster than other antiretroviral classes. More rapid viral load 
      decline has been associated with higher risk of immune reconstitution 
      inflammatory syndrome (IRIS). There are conflicting reports on the association 
      between InSTI and IRIS. We performed a systematic review and meta-analysis to 
      compare the risk of IRIS among treatment-naive HIV-positive patients starting 
      InSTI versus non-InSTI regimens. METHODS: We searched PubMed, Scopus, Web of 
      Science, Africa-Wide, and Cochrane databases from earliest available date to 26 
      November 2021, for randomized controlled trials (RCTs) having intervention arms 
      with InSTI versus control arms without InSTI in patients initiating first-line 
      antiretroviral therapy. The primary outcome was relative risk (RR) of IRIS, 
      whereas the secondary outcome was RR of paradoxical tuberculosis-associated IRIS 
      (TB-IRIS). Data were combined by random-effects meta-analysis according to the 
      Mantel-Haenszel method. The protocol for this study is registered with PROSPERO, 
      CRD42020213976. RESULTS: We included 14 RCTs comprising 8696 participants from 6 
      continents for the primary outcome of IRIS and a subset of 674 participants (from 
      3 RCTs) for the secondary outcome of paradoxical TB-IRIS. Risk of IRIS was 
      similar between InSTI and non-InSTI regimens (RR, 0.93; 95% confidence interval: 
      0.75 to 1.14). There was a trend towards a lower risk of paradoxical TB-IRIS with 
      InSTI versus efavirenz regimens that was not statistically significant (RR, 0.64; 
      95% confidence interval: 0.34 to 1.19). CONCLUSIONS: In this meta-analysis among 
      treatment-naive patients commencing first-line antiretroviral therapy, InSTI 
      regimens were not associated with higher risk of IRIS.
CI  - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Zhao, Ying
AU  - Zhao Y
AUID- ORCID: 0000-0001-7872-0954
AD  - Department of Medicine, University of Cape Town, Cape Town, South Africa.
AD  - Wellcome Centre for Infectious Diseases Research in Africa, Institute of 
      Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 
      South Africa.
FAU - Hohlfeld, Ameer
AU  - Hohlfeld A
AD  - Cochrane South Africa, South African Medical Research Council, Cape Town, South 
      Africa ; and.
FAU - Namale, Phiona
AU  - Namale P
AD  - Department of Medicine, University of Cape Town, Cape Town, South Africa.
AD  - Wellcome Centre for Infectious Diseases Research in Africa, Institute of 
      Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 
      South Africa.
FAU - Meintjes, Graeme
AU  - Meintjes G
AD  - Department of Medicine, University of Cape Town, Cape Town, South Africa.
AD  - Wellcome Centre for Infectious Diseases Research in Africa, Institute of 
      Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 
      South Africa.
FAU - Maartens, Gary
AU  - Maartens G
AD  - Wellcome Centre for Infectious Diseases Research in Africa, Institute of 
      Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, 
      South Africa.
AD  - Division of Clinical Pharmacology, Department of Medicine, University of Cape 
      Town, Cape Town, South Africa .
FAU - Engel, Mark E
AU  - Engel ME
AD  - Department of Medicine, University of Cape Town, Cape Town, South Africa.
LA  - eng
GR  - WT_/Wellcome Trust/United Kingdom
GR  - 203135/WT_/Wellcome Trust/United Kingdom
GR  - 214321/WT_/Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
RN  - 0 (Anti-HIV Agents)
RN  - 0 (HIV Integrase Inhibitors)
RN  - 0 (Integrase Inhibitors)
SB  - IM
MH  - *Anti-HIV Agents/therapeutic use
MH  - *HIV Infections/complications/drug therapy
MH  - *HIV Integrase Inhibitors/therapeutic use
MH  - Humans
MH  - *Immune Reconstitution Inflammatory Syndrome
MH  - Integrase Inhibitors/therapeutic use
MH  - Randomized Controlled Trials as Topic
PMC - PMC7612870
MID - EMS141035
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2022/02/18 06:00
MHDA- 2022/06/18 06:00
PMCR- 2022/06/19
CRDT- 2022/02/17 17:13
PHST- 2021/12/07 00:00 [received]
PHST- 2022/02/02 00:00 [accepted]
PHST- 2022/02/18 06:00 [pubmed]
PHST- 2022/06/18 06:00 [medline]
PHST- 2022/02/17 17:13 [entrez]
PHST- 2022/06/19 00:00 [pmc-release]
AID - 00126334-202206010-00016 [pii]
AID - 10.1097/QAI.0000000000002937 [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2022 Jun 1;90(2):232-239. doi: 
      10.1097/QAI.0000000000002937.