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

• Published in: PloS one Vol. 12; no. 10; p. e0186968
• Main Authors: Andrade, Hugo Boechat, Shinotsuka, Cassia Righy, da Silva, Ivan Rocha Ferreira, Donini, Camila Sunaitis, Yeh Li, Ho, de Carvalho, Frederico Bruzzi, Americano do Brasil, Pedro Emmanuel Alvarenga, Bozza, Fernando Augusto, Miguel Japiassu, Andre
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24-10-2017; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Biology and Life Sciences; Critical Illness; Data analysis; Data processing; Drug therapy; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV patients; Human immunodeficiency virus; Humans; Medicine and Health Sciences; Meta-analysis; Mortality; Patient outcomes; Patients; Physical Sciences; Research and Analysis Methods; Survival; Therapy; Uncertainty analysis; Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0186968

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.
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.
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.
This meta-analysis suggests improved survival rates for HIV positive patients who were treated with HAART during their ICU admission.