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Meta-analysis
Supports Current Guidelines for HAART
Systematic
Review and Meta-Analysis of Evidence for Increasing Numbers of Drugs
in Antiretroviral Combination Therapy
[Jordan R et al. BMJ 2002;324:757]: (http://www.ncbi.nlm.nih.gov/entrez/
query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11923157&dopt=Abstract):
This is a report from investigators in the UK who performed a meta-analysis
on studies of antiretroviral therapy for HIV infection with the
end points of disease progression or death, CD4 cell count, and
viral load. The search through February 2001 showed 700 relevant
papers with 90 that were used in the final analysis; these included
54 clinical trials with 20,404 patients. The following results were
noted:
- Monotherapy:
AZT was the only drug extensively studied and showed a significant
reduction in disease progression with an odds ratio of 0.7, an
increase in CD4 cell count of 47 cells/mm3 and a reduction in
viral load of 0.56 log10 copies/ml. The only long- term study
was the Concorde trial which, at 152 weeks, showed the benefit
of AZT was virtually eliminated.
- Dual
therapy: Most of these trials compared two nucleosides to
AZT monotherapy. The results of dual therapy were substantially
better with an odds ratio for disease progression or death of
0.6.
- Triple
therapy: The benefit compared to dual therapy was an odds
ratio of 0.6, although most of these trials had few events due
to use of viral load as the usual end point.
Comment:
This review is fairly obvious to care providers, but probably represents
an important documentation of the benefit of current guidelines
in terms of providing a comprehensive review of the totality of
data.
Key
words: HAART, antiretroviral therapy
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