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Systematic Review and Meta-analysis of Treatment Interruptions in Human Immunodeficiency Virus (HIV) Type 1–infected Patients Receiving Antiretroviral Therapy: Implications for Future HIV Cure Trials
- Source :
- Clinical Infectious Diseases.
- Publication Year :
- 2019
- Publisher :
- Oxford University Press (OUP), 2019.
-
Abstract
- BackgroundSafety and tolerability of analytical treatment interruptions (ATIs) as a vital part of human immunodeficiency virus type 1 (HIV-1) cure studies are discussed. We analyzed current evidence for the occurrence of adverse events (AEs) during TIs.MethodsOur analysis included studies that reported on AEs in HIV-1–infected patients undergoing TIs. All interventional and observational studies were reviewed, and results were extracted based on predefined criteria. The proportion of AEs was pooled using random-effects models. Metaregression was used to explore the influence of baseline CD4+ T-cell count, viral load, study type, previous time on combined antiretroviral therapy, and follow-up interval during TIs.ResultsWe identified 1048 studies, of which 22 studies including 7104 individuals fulfilled the defined selection criteria. Included studies had sample sizes between 6 and 5472 participants, with durations of TI cycles ranging from 7 days to 27 months. The intervals of HIV-1-RNA testing varied from 2 days to 3 months during TIs. The overall proportion of AEs during TIs >4 weeks was 3% (95% confidence interval [CI], 0%–7%) and was lower in studies with follow-up intervals ≤14 days (0%; 95% CI, 0%–1%) than in studies with wider follow-up intervals (6%; 95% CI, 2%–13%; P value for interaction = .01).ConclusionsWe found moderate-quality evidence indicating that studies with narrow follow-up intervals did not show a substantial increase in AEs during TIs. Our findings indicate that ATI may be a safe strategy as part of HIV-1 cure trials by closely monitoring for HIV-1 rebound.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
HIV Infections
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Adverse effect
business.industry
Drug holiday
Viral Load
Confidence interval
CD4 Lymphocyte Count
030104 developmental biology
Infectious Diseases
Anti-Retroviral Agents
Tolerability
Sample size determination
Meta-analysis
HIV-1
Observational study
business
Viral load
Subjects
Details
- ISSN :
- 15376591 and 10584838
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases
- Accession number :
- edsair.doi.dedup.....835623ca6c516c3f44701d2853e59363