Risk of failure in dual therapy versus triple therapy in naive HIV-patients: A systematic review and meta-analysis

BACKGROUND: Several attempts have been made to test different drug-sparing strategies to reduce the drug-burden and drug-related toxicities. OBJECTIVE: The objective of this meta-analysis was to evaluate the relative risk of failure of dual therapies compared to triple therapies in HIV-naA_ve patients. DATA SOURCES: We searched MEDLINE, Google Scholar and the Cochrane Library. STUDY ELIGIBILITY CRITERIA: The following criteria were used: present data from original articles comparing the two treatment regimens; be published from January 2007 up to January, 2020. No language or study design restriction was applied. PARTICIPANTS: and interventions: HIV-positive naA_ve patients treated with dual or triple antiretroviral therapy (ART) METHODS: A systematic review and meta-analysis was performed. Treatment failure was the primary outcome evaluated; heterogeneity was assessed using the Q statistic and I(2). RESULTS: Fourteen studies were included, allowing a meta-analysis on 5,205 patients. The meta-analysis performed on studies that presented data at 48Aÿweeks showed that the relative risk (RR) of treatment failure (TF) (RR>1 favoring triple therapy) in 10 studies was 1.20 (95%CI: 0.91-1.59, I(2): 49.2%); the RR of virological failure (VF) in 8 studies was 1.54 (95%CI: 0.84-2.86, I(2): 54%); the RR of adverse drug reaction leading to discontinuation of the regimen at 48Aÿweeks in 8 studies was 0.76 (95%CI: 0.43-1.33, I(2): 17.7%). In patients with less than 200 CD4+, the RR of TF in 2 studies without maraviroc was 2.09 (95%CI: 1.05-4.17, I(2): 0.0%). Regarding the studies at 96Aÿweeks there was no difference except in rate of development of resistance, RR 1.94 (95%CI: 1.06-3.53, I(2): 6.2%). CONCLUSION: Dual therapy are as effective as those with three drugs, showing no difference according to the different dual therapies, except in patients with less than 200 CD4; however, they are associated with a higher selection of resistance-associated mutations at 96Aÿweeks of therapy

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Prevention
  • Biomedical interventions