Highly active antiretroviral therapy for critically ill HIV patients: A systematic review and meta-analysis.

Autor: Andrade HB; Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil., Shinotsuka CR; Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil., da Silva IRF; Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil., Donini CS; Infectious Diseases Intensive Care Unit of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil., Yeh Li H; Infectious Diseases Intensive Care Unit of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brazil., de Carvalho FB; Intensive Care Unit of Hospital Eduardo de Menezes da Fundação Hospitalar do Estado de Minas Gerais. Belo Horizonte, MG, Brazil., Americano do Brasil PEA; Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil., Bozza FA; Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil., Miguel Japiassu A; Intensive Care Unit of Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro, RJ, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2017 Oct 24; Vol. 12 (10), pp. e0186968. Date of Electronic Publication: 2017 Oct 24 (Print Publication: 2017).
DOI: 10.1371/journal.pone.0186968
Abstrakt: Introduction: It is unclear whether the treatment of an HIV infection with highly active antiretroviral therapy (HAART) affects intensive care unit (ICU) outcomes. In this paper, we report the results of a systematic review and meta-analysis performed to summarize the effects of HAART on the prognosis of critically ill HIV positive patients.
Materials and Methods: A bibliographic search was performed in 3 databases (PubMed, Web of Science and Scopus) to identify articles that investigated the use of HAART during ICU admissions for short- and long-term mortality or survival. Eligible articles were selected in a staged process and were independently assessed by two investigators. The methodological quality of the selected articles was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool.
Results: Twelve articles met the systematic review inclusion criteria and examined short-term mortality. Six of them also examined long-term mortality (≥90 days) after ICU discharge. The short-term mortality meta-analysis showed a significant beneficial effect of initiating or maintaining HAART during the ICU stay (random effects odds ratio 0.53, p = 0.02). The data analysis of long-term outcomes also suggested a reduced mortality when HAART was used, but the effect of HAART on long-term mortality of HIV positive critically ill patients remains uncertain.
Conclusions: This meta-analysis suggests improved survival rates for HIV positive patients who were treated with HAART during their ICU admission.
Databáze: MEDLINE
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