Choice of Antiretroviral Drugs for Postexposure Prophylaxis for Adults and Adolescents: A Systematic Review
| العنوان: | Choice of Antiretroviral Drugs for Postexposure Prophylaxis for Adults and Adolescents: A Systematic Review |
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| المؤلفون: | Marco Vitoria, Meg Doherty, Olawale Ajose, Zara Shubber, Kenneth H. Mayer, Cristiane Rapparini, Rachel Beanland, Cadi Irvine, Nathan Ford, Alexandra Calmy |
| المصدر: | Clinical Infectious Diseases. 60:S170-S176 |
| بيانات النشر: | Oxford University Press (OUP), 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Adult, Microbiology (medical), medicine.medical_specialty, Adolescent, Anti-HIV Agents, HIV Infections, Pharmacology, World Health Organization, Emtricitabine, Lopinavir, Antiretroviral Therapy, Highly Active, Internal medicine, medicine, Humans, Tenofovir, Darunavir, Ritonavir, business.industry, HIV, Lamivudine, Raltegravir, Atazanavir, Regimen, Infectious Diseases, Drug Therapy, Combination, Post-Exposure Prophylaxis, business, medicine.drug |
| الوصف: | Background. The choice of preferred regimens for human immunodeficiency virus postexposure prophylaxis (PEP) has evolved over the last 2 decades as more data have become available regarding the safety and tolerability of newer antiretroviral drugs. We undertook a systematic review to assess the safety and efficacy of antiretroviral options for PEP to inform the World Health Organization guideline revision process. Methods. Four databases were searched up to 1 June 2014 for studies reporting outcomes associated with specific PEP regimens. Data on PEP completion and discontinuation due to adverse events was extracted and pooled estimates were obtained using random-effects meta-analyses. Results. Fifteen studies (1830 PEP initiations) provided evaluable information on 2-drug regimens (zidovudine [ZDV]- or tenofovir [TDF]-based regimens), and 10 studies (1755 initiations) provided evaluable information on the third drug, which was usuallya protease inhibitor. The overall qualityof the evidencewas rated as very low. For the 2drug regimen, PEP completion rates were 78.4% (95% confidence interval [CI], 66.1%–90.7%) for people receiving a TDF-based regimen and 58.8% (95% CI, 47.2%–70.4%) for a ZDV-based regimen; the rate of PEP discontinuation due to an adverse event was lower among people taking TDF-based PEP (0.3%; 95% CI, 0%–1.1%) vs a ZDV-based regimen (3.2%; 95% CI, 1.5%–4.9%). For the 3-drug comparison, PEP completion rates were highest for the TDF-based regimens (TDF+emtricitabine [FTC]+lopinavir/ritonavir [LPV/r], 71.1%; 95% CI, 43.6%–98.6%; TDF+ FTC+raltegravir [RAL], 74.7%; 95% CI, 41.4%–100%; TDF+FTC+ boosted darunavir [DRV/r], 93.9%; 95% CI, 90.2%–97.7%) and lowest for ZDV+ lamivudine [3TC]+LPV/r (59.1%; 95% CI, 36.2%–82.0%). Discontinuations due to adverse drug reactions were lowest for TDF+FTC+RAL (1.9%; 95% CI, 0%–3.8%) and highest for ZDV+3TC+ boosted atazanavir (21.2%; 95% CI, 13.5%–30.0%). Conclusions. The findings of this review provide evidence supporting the use of coformulated TDF and 3TC/ FTC as preferred backbone drugs for PEP. Choice of third drug will depend on setting; for resource-limited settings, LPV/r is a reasonable choice, pending the improved availabilityof better-tolerated drugs with less potential for drug– drug interactions. |
| تدمد: | 1537-6591 1058-4838 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::83ebd21f8bd43bb2b67e41321ab2e6c8 https://doi.org/10.1093/cid/civ092 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....83ebd21f8bd43bb2b67e41321ab2e6c8 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15376591 10584838 |
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