Nevirapine versus efavirenz for patients co-infected with HIV and tuberculosis: a systematic review and meta-analysis

作者：Hai‐yin Jiang, Minna Zhang, Haijun Chen, Ying Yang, Min Deng, Bing Ruan · 发表于：International Journal of Infectious Diseases · 年份：2014 · DOI：10.1016/j.ijid.2014.04.020 · 被引用次数：29 · 研究领域：HIV/AIDS drug development and treatment、Pneumocystis jirovecii pneumonia detection and treatment、Tuberculosis Research and Epidemiology

OBJECTIVES: Antiretroviral therapy (ART) reduces the morbidity and mortality of patients infected with HIV. Standard ART includes either nevirapine or efavirenz, however the efficacy of these drugs is limited in patients receiving rifampin treatment for tuberculosis (TB). We compared the efficacy and safety of nevirapine- and efavirenz-based ART regimens in patients co-infected with both HIV and TB through a systematic review and meta-analysis. METHODS: A comprehensive search of the literature was carried out to identify clinical trials comparing the efficacy and safety of nevirapine- and efavirenz-based ART regimens in HIV-associated TB. Eligible clinical studies included at least one primary or secondary event; the primary event was virological response and secondary events were TB treatment outcomes, mortality, and safety profile. RESULTS: This meta-analysis compared five randomized clinical trials and four retrospective clinical trials. Both included patients co-infected with HIV and TB; 833 received nevirapine, while 1424 received efavirenz. The proportion of patients achieving a virological response by the end of the follow-up was higher in the efavirenz group: plasma viral load <400 copies/ml, risk ratio (RR) 1.10, 95% confidence interval (CI) 1.03-1.17 (p = 0.004); plasma viral load<50 copies/ml, RR 1.07, 95% CI 0.98-1.16 (p = 0.146). No significant differences were found in either mortality (RR 0.70, 95% CI 0.44-1.13, p = 0.142) or TB treatment outcomes (RR 1.01, 95%...