Immunological Effects of Integrase Inhibitors as Part of Initial Therapy in People Living with HIV: A Systematic Literature Review
DOI:
https://doi.org/10.17533/udea.iatreia.255Keywords:
HIV Integrase Inhibitors, Immune Reconstitution, Systematic Review, Antiretroviral Therapy, Highly ActiveAbstract
Introduction: The use of integrase inhibitors within highly active antire-troviral therapy (HAART) has demonstrated benefits for individuals living with HIV. However, most comparisons are based on effectiveness against viral replication, with limited information on their impact on the immune system.
Objective: To identify immunological outcomes in studies comparing in- tegrase inhibitors (INSTIs) with other drugs used as third agents in HAART.
Methods: Systematic review of studies reporting patients treated with INS- TIs versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or pro-tease inhibitors (PIs) as the third drug in HAART. Immunological reconstitution outcomes were assessed, including CD4+ T lymphocyte count, CD4/ CD8 ratio, serum concentration of sCD14, D-dimer, and C-reactive protein, as well as the frequency and phenotype of T cells, functional capacity of T cells, and proviral DNA.
Results: A total of 2804 studies were screened, 59 were evaluated in full text and four were included in the synthesis. A cohort study reported normalization of the CD4/CD8 ratio in patients initiating treatment with INSTIs compared to PIs or NNRTIs. However, this finding was not consistently replicated in other studies, and in one of them, this ratio was higher in those receiving efavirenz vs. dolutegravir. No evidence was found for other outcomes.
Conclusions: The analyzed studies are inconclusive regarding differences in immunological reconstitution between INSTIs vs. PIs and NNRTIs.
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