Association between the use of protease inhibitors in Highly Active Antiretroviral Therapy (HAART) and incidence of metabolic syndrome in HIV-infected patients: A systematic review and meta-analysis

Introduction: Since its introduction, Highly Active Antiretroviral Treatment (HAART) has been shown to prolong the life expectancy of HIV-infected patients. HIV and HAART, especially protease inhibitors (PIs), have been associated with the occurrence of Metabolic Syndrome (MS). The objective of this systematic review and meta-analysis was to determine whether there is an association between the use of PIs and the incidence of MS in HIV-infected patients. Methods: A comprehensive search (including databases such as MEDLINE/PubMed, CENTRAL, LILACS and EMBASE) was performed. Observational studies published until November 2015 were included. Inclusion criteria for primary studies were: study population comprised HIV-infected patients aged 18 years or older and who were receiving HAART; patients assessed according to their use of PIs; DM as defined by the primary study. Heterogeneity was assessed and a pooled analysis was performed using a random-effects model. Results: 3 articles met the inclusion criteria, describing 586 HIV patients. Use of PIs was associated with the development of MS (RR: 2.11; 95% CI 1.28 to 3.48; 〖Chi〗^2:0.04, I^2: 0%; p-value 0.003). Conclusion: Use of PIs in HIV-infected patients is associated with an increased risk of MS. These findings are of relevance for future public policy because it will increase the interest in screening and prevention of MS in an expanding population.Tesi

Association between the use of protease inhibitors in highly active antiretroviral therapy and incidence of diabetes mellitus and/or metabolic syndrome in HIV-infected patients: A systematic review and meta-analysis

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.This systematic review and meta-analysis tries to determine whether there is an association between the use of protease inhibitors (PIs) and the incidence of diabetes mellitus (DM) and/or metabolic syndrome (MS) in HIV-infected patients. A systematic literature search was performed using MEDLINE/PubMed, CENTRAL, LILACS, and EMBASE. Included articles were observational studies published on or prior to November 2015 that met specific inclusion criteria. Pooled relative risks (RRs) and hazard ratios (HRs) were calculated. Nine articles met the inclusion criteria, describing 13,742 HIV patients. Use of PIs was associated with the development of MS (RR: 2.11; 95% CI 1.28–3.48; p-value 0.003). No association between the use of PIs and development of DM was found: the HR for the incidence of DM among patients using PIs was 1.23 (95% CI 0.66–2.30; p-value: 0.51) and the RR was 1.25 (95% CI 0.99–1.58; p-value 0.06). Use of PIs in HIV-infected patients is associated with an increased risk of MS. No evidence of an increased risk of DM was found. However, because MS is a precursor to DM, it is possible that studies with a longer follow-up duration are needed in order to detect an association between PI use and onset of DM.First, we would like to thank our families for all their support. Second, we would like to thank the Universidad Peruana de Ciencias Aplicadas, the Health Sciences Department, and the School of Medicine for their support and for all the tools they have provided throughout this process. Finally, we want to thanks to Dr Gwenyth O. Lee and Dr Daniela E. Kirwan for their comments.Revisión por pare