抗逆转录病毒疗法治疗艾滋病疗效与安全性的网状 Meta分析

The comparative efficacy of antiretroviral therapies for acquired immunodeficiency syndrome: a network meta-analysis

摘要

目的 比较不同抗逆转录病毒疗法的有效性与安全性。方法 系统检索国内外抗逆转录病毒治疗艾滋病的随机对照试验，采用Cochrane偏倚风险评估工具评价随机对照试验的质量，使用Stata 17.0软件进行数据分析，效应量采用比值比及95%可信区间表示，并使用累积排序概率曲线下面积值对干预措施进行排序。结果 最终纳入36篇随机对照试验，其中19项研究为中低偏倚风险。网状Meta分析结果表明，在抗病毒治疗的短期（48周）和长期（96周）疗效上，基于新型整合酶抑制剂的治疗方案显示出较好疗效。48周时，替诺福韦艾拉酚胺+恩曲他滨+多替拉韦与替诺福韦艾拉酚胺+恩曲他滨+比克替拉韦的病毒抑制率显著优于多个基于非核苷逆转录酶抑制剂或早期蛋白酶抑制剂的传统方案。96周时，基于多替拉韦的方案（包括替诺福韦+恩曲他滨+多替拉韦和阿巴卡韦+拉米夫定+多替拉韦）病毒抑制率显著高于传统方案，并且优于48周的替诺福韦艾拉酚胺+恩曲他滨+多替拉韦方案。不良事件发生率不同方案之间无显著差异。结论 替诺福韦艾拉酚胺+恩曲他滨+多替拉韦和替诺福韦+拉米夫定/恩曲他滨+利匹韦林方案有效性和安全性相对较好，可能为艾滋病患者的长期抗病毒治疗提供可靠的方案。

Abstract

Objective To compare the efficacy and safety of different antiretroviral therapy regimens. Methods Randomized controlled trials related antiretroviral therapies for acquired immunodeficiency syndrome were systematically retrieved from domestic and international databases. The Cochrane Risk of Bias Tool was used to assess the quality of the randomized controlled trials. Data analysis was performed using Stata 17.0 software, with effect sizes expressed as odds ratios and 95% confidence intervals. Interventions were ranked using the surface under the cumulative ranking curve values. Results A total of 36 randomized controlled trials were included, of which 19 studies were assessed as having moderate-to-low risk of bias. Network meta-analysis results showed that regimens based on newer integrase strand transfer inhibitors demonstrated significant advantages in both short-term (48-week) and long-term (96-week) antiviral efficacy. At 48 weeks, the tenofovir alafenamide + emtricitabine + dolutegravir and tenofovir alafenamide + emtricitabine + bictegravir regimens achieved significantly higher viral suppression rates compared to several traditional regimens based on non-nucleoside reverse transcriptase inhibitors or earlier protease inhibitors. At 96 weeks, DTG-based regimens (including tenofovir disoproxil fumarate+emtricitabine+dolutegravir and abacavir + lamivudine + dolutegravir) showed significantly higher viral suppression rates than traditional regimens and were superior to the 48-week tenofovir alafenamide+emtricitabine + dolutegravir regimen. No significant differences in the incidence of adverse events were observed among the different regimens. Conclusion The tenofovir alafenamide+emtricitabine+dolutegravir and tenofovir disoproxil fumarate+emtricitabine / lamivudine + rilpivirine regimens demonstrated relatively better efficacy and safety, potentially offering reliable long-term antiviral treatment options for acquired immune deficiency syndrome patients.

关键词

艾滋病 / 抗逆转录病毒疗法 / 网状Meta分析 / 疗效 / 安全性 / 治疗方案 / 随机对照研究

Key words

acquired immunodeficiency syndrome / antiretroviral therapy / network Meta-analysis / efficacy / safeness / therapeutic regimen / randomized controlled trial

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基金资助

甘肃省科技计划项目(23JRRA1457)

兰州市科技计划项目(2024-9-204)

兰州市科技计划项目(2025-2-28)

兰州市城关区科技计划项目(2024-11-14)