1. Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment.
- Author
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Ford N, Vitoria M, Rangaraj A, Norris SL, Calmy A, and Doherty M
- Subjects
- Adult, Anti-Retroviral Agents therapeutic use, Betacoronavirus, COVID-19, Coronavirus isolation & purification, Coronavirus Infections epidemiology, Drug Combinations, Female, Humans, Lopinavir, Male, Middle Aged, Pandemics, Pneumonia, Viral epidemiology, Ritonavir, Severe acute respiratory syndrome-related coronavirus drug effects, SARS-CoV-2, Severe Acute Respiratory Syndrome drug therapy, Severe Acute Respiratory Syndrome epidemiology, COVID-19 Drug Treatment, Antiretroviral Therapy, Highly Active, Coronavirus drug effects, Coronavirus Infections drug therapy, Pneumonia, Viral drug therapy
- Abstract
Introduction: Several antiretroviral drugs are being considered for the treatment of COVID-19, the disease caused by a newly identified coronavirus, (SARS-CoV-2). We systematically reviewed the clinical outcomes of using antiretroviral drugs for the prevention and treatment of coronaviruses and planned clinical trials., Methods: Three databases were screened from inception to 30 March 2020 for studies reporting clinical outcomes of patients with SARS, MERS or COVID-19 treated with antiretrovirals., Results: From an initial screen of 433 titles, two randomized trials and 24 observational studies provided clinical outcome data on the use of antiretroviral drugs; most studies reported outcomes using LPV/r as treatment. Of the 21 observational studies reporting treatment outcomes, there were three studies among patients with SARS, six studies among patients with MERS and 12 studies among patients with COVID-19. In one randomized trial 99 patients with severe COVID-19 illness were randomized to receive LPV/r (400/100 mg twice a day) and 100 patients to standard of care for 14 days: LPV/r was not associated with a statistically significant difference in time to clinical improvement, although LPV/r given within 12 days of symptoms was associated with shorter time to clinical improvement; 28 day mortality was numerically lower in the LPV/r group (14/99) compared to the control group (25/100), but this difference was not statistically significant. The second trial found no benefit. The certainty of the evidence for the randomized trials was low. In the observational studies 3 out of 361 patients who received LPV/r died; the certainty of evidence was very low. Three studies reported a possible protective effect of LPV/r as post-exposure prophylaxis. Again, the certainty of the evidence was very low due to uncertainty due to limited sample size., Conclusions: On the basis of the available evidence it is uncertain whether LPV/r and other antiretrovirals improve clinical outcomes or prevent infection among patients at high risk of acquiring COVID-19., (© 2020 World Health Organization; licensed by by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
- Published
- 2020
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