Takeaway
- In treatment-naïve people with HIV, the effects of quadruple combination antiretroviral therapy (cART) were not better than triple cART for first-line treatment.
Why this matters
- Finding adds support to current guidelines and suggests no need to update recommendations of triple therapy on first-line treatment.
Study design
- Meta-analysis of 12 studies involving 4251 patients with HIV compared the effects of quadruple with triple cART in treatment-naive patients with HIV.
- Outcomes included undetectable HIV-1 RNA, CD4 T-cell count, virological failure, new AIDS-defining events, death, and severe adverse effects.
- Funding: None.
Key results
- Quadruple and triple cART demonstrated similar effects on all interested outcomes and none of the point estimates favoured quadruple cART.
- With the triple therapy as the reference group, the risk ratio (RR) was:
- undetectable HIV-1 RNA (9 studies, n=3622; RR, 0.99; 95% CI, 0.93-1.05; I2=41%),
- virological failure (5 studies, n=2887; RR, 1.00; 95% CI, 0.90-1.11; I2=23%),
- new AIDS-defining events (3 studies, n=1338; RR, 1.17; 95% CI, 0.84-1.63; I2=0%),
- death (5 studies, n=2379; RR, 1.23; 95% CI, 0.74-2.05; I2=0%), and
- severe adverse effects (5 studies, n= 2951; RR, 1.09; 95% CI, 0.89-1.33; I2=48%).
- The overall mean difference in CD4 T-cell count increase between the groups was −19.55 cells/μL (95% CI, −43.02 to 3.92 cells/μL; I2=22%; 5 studies, n=1819).
Limitations
- Risk of bias.
- Heterogeneity among included studies.
References
References