Comparative effectiveness of tenofovir in treatment-naive HIV-infected patients: Systematic review and meta-analysis

INTRODUCTION: Benefits and harms of tenofovir disoproxil fumarate (TDF) in HIV-infected, antiretroviral treatment (ART)-naive patients of any age have not been systematically reviewed since recent milestone trials were published. METHODS: We searched MEDLINE, EMBASE, CENTRAL, SCI, LILACS, WHO GHL, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing TDF-based treatments with any other ART-regimen (last search 01/2015). Trial characteristics and results were extracted, risks of bias systematically assessed, and treatment effects synthesized in meta-analyses using random-effects models. RESULTS: We included 22 RCTs (8297 patients). We found no differences between groups for mortality, AIDS, fractures, CD4 cell count, and virological failure; and inconclusive information due to inadequate reporting for cardiovascular events, renal failure, proteinuria, rash, and quality of life. Tenofovir disoproxil fumarate-based regimens significantly reduced total cholesterol (mean difference – 18.42 mg/dl; 95% confidence interval [CI] – 22.80 to – 14.0), LDL-cholesterol ( – 9.53 mg/dl; – 12.16 to – 6.89), HDL-cholesterol ( – 2.97 mg/dl; – 4.41 to – 1.53), and triglycerides ( – 29.77 mg/dl; – 38.61 to – 20.92), bone mineral density (BMD) (hip: – 1.41%; – 1.87 to – 0.94), and glomerular filtration rate (eGFR) ( – 3.47 ml/minute; – 5.89 to – 1.06) over 48 weeks of follow-up. Effects were similar in trials comparing fixed-dose TDF/FTC-based regimens with ABC/3TC-based regimens. We found no influence of baseline viral load on virological failure. DISCUSSION: Moderate-quality evidence suggests similar effects of TDF-based treatment regimens and other ART on virological failure. Tenofovir disoproxil fumarate-based regimens are associated with a more favorable lipid profile, but with increased risk of reduced BMD and eGFR. Improved reporting quality is vital to allow assessment of clinical outcomes in future trials.

• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Co-morbidities
  • Cardiovascular
  • Other