Integrase inhibitors versus efavirenz combination antiretroviral therapies for TB/HIV coinfection: a meta-analysis of randomized controlled trials

• Published in: AIDS research and therapy 2021-05, Vol.18 (1), p.25-8, Article 25
• Main Authors: Shu, Yuanlu, Deng, Ziwei, Wang, Hongqiang, Chen, Yi, Yuan, Lijialong, Deng, Ye, Tu, Xiaojun, Zhao, Xiang, Shi, Zhihua, Huang, Minjiang, Qiu, Chengfeng
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adverse events; AIDS; Alkynes; Anti-HIV Agents - adverse effects; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Bacteriology; Benzoxazines - adverse effects; Bias; Care and treatment; CD4 antigen; Clinical trials; Coinfection - drug therapy; Collaboration; Comorbidity; Comparative analysis; Cyclopropanes; Demographic aspects; Dolutegravir; Dosage and administration; Drug dosages; Drug interactions; Drug resistance; Drug therapy; Efavirenz; HIV; HIV Infections - drug therapy; HIV patients; Human immunodeficiency virus; Humans; Infections; Inhibitors; Integrase; Integrase inhibitors; Integrase Inhibitors - therapeutic use; Meta-analysis; Patients; Raltegravir; Randomized Controlled Trials as Topic; Review; Risk factors; Safety; Tuberculosis
• ISSN: 1742-6405; 1742-6405
• DOI: 10.1186/s12981-021-00348-w

Integrase inhibitors (INIs)-based antiretroviral therapies (ART) are more recommended than efavirenz (EFV)-based ART for people living with HIV/AIDS (PLWHA). Yet, the advantage of integrase inhibitors in treating TB/HIV coinfection is uncertain. Therefore, the objective of this systematic review is to evaluate the effects and safety of INIs- versus EFV-based ART in TB/HIV coinfection, and demonstrate the feasibility of the regimens. Four electronic databases were systematically searched through September 2020. Fixed-effects models were used to calculate pooled effect size for all outcomes. The primary outcomes were virologic suppression and bacteriology suppression for INIs- versus EFV-based ART. Secondary outcomes included CD4 cell counts change from baseline, adherence and safety. Three trials (including 672 TB/HIV patients) were eligible. ART combining INIs and EFV had similar effects for all outcomes, with none of the point estimates argued against the INIs-based ART on TB/HIV patients. Compared to EFV-based ART as the reference group, the RR was 0.94 (95% CI 0.85 to 1.05) for virologic suppression, 1.00 (95% CI 0.95 to 1.05) for bacteriology suppression, 0.98 (95% CI 0.95 to 1.01) for adherence. The mean difference in CD4 cell counts increase between the two groups was 14.23 cells/μl (95% CI 0- 6.40 to 34.86). With regard to safety (adverse events, drug-related adverse events, discontinuation for drugs, grade 3-4 adverse events, IRIS (grade 3-4), and death), INIs-based regimen was broadly similar to EFV-based regimens. The analytical results in all sub-analyses of raltegravir- (RAL) and dolutegravir (DTG) -based ART were valid. This meta-analysis demonstrates similar efficacy and safety of INIs-based ART compared with EFV-based ART. This finding supports INIs-based ART as a first-line treatment in TB/HIV patients. The conclusions presented here still await further validation owing to insufficient data.