Transmitted drug resistance in ART-naive persons with acute/ early/ primary HIV infection: a systematic review and meta-analysis

Abstract Background: In the absence of AIDS vaccine，antiretroviral therapy (ART) was the most effective tool to prevent and control the HIV pandemic. But the widespread use of ART has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with acute/ primary/ early HIV infection, and describe the critical drug-resistant mutations. Methods: We systematically reviewed 1192 studies published between January 1, 2008 and December 30, 2019 in PubMed, Web of Science, Embase, and the Cochrane Library, and selected 12 studies that meet our inclusion criteria. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE. Estimates of mixed-effects were calculated by random-effects meta-analysis, and the I²statistics were used to estimate the heterogeneity of all included studies.Results: The Data of this meta-analysis come from 12 observational studies, covering 3558 ART-naive individuals with PHI, AHI or EHI. The overall prevalence of HIV-TDR is 9.8% (95% confidence interval (CI): 7.2%–12.3%, p<0.001). Prevalence of resistance by drug class is highest for the NNRTIs at 5.9% (95% CI: 3.1%–8.6%, p<0.001), followed by NRTIs 3.4% (95% CI: 1.8%–5.0%, p<0.001) and PIs 3.4% (95% CI: 2.7%–4.0%, p<0.001). The prevalence of TDR to INIs is 0.3% (95% CI: -0.1%-0.7%, p<0.001), which is the lowest among all antiretroviral drugs.Conclusion: The overall prevalence of TDR is high among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.

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Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.718763 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chunxiang Guo ◽

Yaxin Wu ◽

Yang Zhang ◽

Xinchao Liu ◽

Aixin Li ◽

...

Keyword(s):

Drug Resistance ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Reverse Transcriptase ◽

Meta Analysis ◽

Antiretroviral Drugs ◽

Cochrane Library ◽

Transmitted Drug Resistance ◽

Reverse Transcriptase Inhibitors ◽

Primary Hiv Infection

Background: The widespread use of antiretroviral therapy (ART) has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with primary HIV infection (PHI)/AHI/early HIV infection (EHI) and to describe the critical drug-resistant mutations.Methods: We systematically searched the literature between January 1, 2008, and April 30, 2021, in PubMed, Web of Science, Embase, and the Cochrane Library. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE.Results: The data of this meta-analysis come from 12 observational studies, covering 3,558 ART-naive individuals with PHI, AHI, or EHI. The overall prevalence of HIV-TDR is 9.3% (95% CI: 6.8%–11.8%, I2 = 81.1%, in 11 studies). The prevalence of resistance by drug class is the highest for the nonnucleoside reverse transcriptase inhibitors (NNRTIs) at 5.7% (95% CI: 2.9%–8.5%, I2 = 96.6%, in 11 studies), followed by nucleoside reverse transcriptase inhibitors (NRTIs) at 3.4% (95% CI: 1.8%–5.0%, I2 = 86.3%, in 10 studies) and protease inhibitors (PIs) at 3.3% (95% CI: 2.7%–3.9%, I2 = 15.6%, in 10 studies). The prevalence of TDR to integrase inhibitors (INIs) is 0.3% (95% CI: 0.1%–0.7%, I2 = 95.9%, in three studies), which is the lowest among all antiretroviral drugs.Conclusion: The overall prevalence of TDR is at a moderate level among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.

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Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa182 ◽

2020 ◽

Vol 112 (4) ◽

pp. 1069-1079

Author(s):

Radhini Karunaratne ◽

Jonathan P Sturgeon ◽

Rajvi Patel ◽

Andrew J Prendergast

Keyword(s):

Systematic Review ◽

Hiv Infection ◽

Severe Acute Malnutrition ◽

Meta Analysis ◽

Multivariable Analysis ◽

Acute Malnutrition ◽

Cochrane Library ◽

Inpatient Mortality ◽

Baseline Factors ◽

The Cochrane Library

ABSTRACT Background Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%–40%) among children requiring hospitalization for complicated SAM. Objectives We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM. Methods Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where >20% of studies included the same factor in analyses. Results Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies. Conclusions HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM. This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.

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Prevalence Trend of Transmitted Drug Resistance in a Prospective Cohort of Thai People with Acute HIV Infection

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000002718 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Muccini Camilla ◽

Pinyakorn Suteeraporn ◽

Sirivichayakul Sunee ◽

Kroon Eugene ◽

Sacdalan Carlo ◽

...

Keyword(s):

Drug Resistance ◽

Hiv Infection ◽

Prospective Cohort ◽

Transmitted Drug Resistance ◽

Acute Hiv Infection ◽

Acute Hiv ◽

Thai People

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Declining trend in transmitted drug resistance detected in a prospective cohort study of acute HIV infection in Bangkok, Thailand

Journal of the International AIDS Society ◽

10.7448/ias.19.1.20966 ◽

2016 ◽

Vol 19 (1) ◽

pp. 20966 ◽

Cited By ~ 6

Author(s):

Donn J Colby ◽

Trevor A Crowell ◽

Sunee Sirivichayakul ◽

Suteeraporn Pinyakorn ◽

Eugene Kroon ◽

...

Keyword(s):

Drug Resistance ◽

Cohort Study ◽

Hiv Infection ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Transmitted Drug Resistance ◽

Acute Hiv Infection ◽

Acute Hiv

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Effects of Dexmedetomidine as an Analgesic Adjuvant for Surgery of Femur Fracture: A Systematic Review and Meta-Analysis

Pharmacology ◽

10.1159/000515788 ◽

2021 ◽

pp. 1-9

Author(s):

Shan Deng ◽

Yonghao Yu

Keyword(s):

Femur Fracture ◽

Meta Analysis ◽

Sensory Block ◽

Cochrane Library ◽

Rescue Analgesia ◽

Block Level ◽

Block Time ◽

Sedation Scores ◽

The Difference ◽

The Cochrane Library

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

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EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211004277 ◽

2021 ◽

pp. 174749302110042

Author(s):

Grace Mary Turner ◽

Christel McMullan ◽

Olalekan Lee Aiyegbusi ◽

Danai Bem ◽

Tom Marshall ◽

...

Keyword(s):

Systematic Review ◽

Stroke Risk ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Cochrane Library ◽

Control Group ◽

Large Sample Size ◽

Hazard Ratios ◽

Increased Risk ◽

The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

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Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer: a systematic review and meta-analysis

Surgical Endoscopy ◽

10.1007/s00464-021-08615-7 ◽

2021 ◽

Author(s):

Jae Young Moon ◽

Min Ro Lee ◽

Gi Won Ha

Keyword(s):

Rectal Cancer ◽

Meta Analysis ◽

Disease Free Survival ◽

Distant Recurrence ◽

Oncologic Outcomes ◽

Cochrane Library ◽

Transanal Total Mesorectal Excision ◽

Random Effects Models ◽

The Cochrane Library

Abstract Background Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer. Methods PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence. Results We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39–1.09, I2 = 0%), 0.79 (95% CI 0.57–1.10, I2 = 0%), 1.14 (95% CI 0.44–2.91, I2 = 66%), and 0.75 (95% CI 0.40–1.41, I2 = 0%), respectively. Conclusion In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.

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Appendectomy Does Not Increase the Risk of Future Emergence of Parkinson’s Disease: A Meta-analysis

The American Surgeon ◽

10.1177/0003134821989034 ◽

2021 ◽

pp. 000313482198903

Author(s):

Mitsuru Ishizuka ◽

Norisuke Shibuya ◽

Kazutoshi Takagi ◽

Hiroyuki Hachiya ◽

Kazuma Tago ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Models ◽

Significant Difference ◽

The Cochrane Library ◽

The Impact ◽

The Relationship ◽

Observation Period

Objective To explore the impact of appendectomy history on emergence of Parkinson’s disease (PD). Background Although there are several studies to investigate the relationship between appendectomy history and emergence of PD, the results are still controversial. Methods We performed a comprehensive electronic search of the literature (the Cochrane Library, PubMed, and the Web of Science) up to April 2020 to identify studies that had employed databases allowing comparison of emergence of PD between patients with and those without appendectomy history. To integrate the impact of appendectomy history on emergence of PD, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI) for the selected studies, and heterogeneity was analyzed using I2 statistics. Results Four studies involving a total of 6 080 710 patients were included in this meta-analysis. Among 1 470 613 patients with appendectomy history, 1845 (.13%) had emergences of PD during the observation period, whereas among 4 610 097 patients without appendectomy history, 6743 (.15%) had emergences of PD during the observation period. These results revealed that patients with appendectomy history and without appendectomy had almost the same emergence of PD (RR, 1.02; 95% CI, .87-1.20; P = .83; I2 = 87%). Conclusion This meta-analysis has demonstrated that there was no significant difference in emergence of PD between patients with and those without appendectomy history.

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Lumbar Roll Usage While Sitting Reduces the Forward Head Posture in Healthy Individuals: A Systematic Review with Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105171 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5171

Author(s):

Yusuke Handa ◽

Kenya Okada ◽

Hiroshi Takasaki

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grade System ◽

Cochrane Library ◽

Forward Head Posture ◽

Quality Of Evidence ◽

Head Posture ◽

Head Extension ◽

The Cochrane Library

This systematic review and meta-analysis investigated whether the use of a lumbar roll reduced forward head posture (FHP) while sitting among individuals with or without musculoskeletal disorders. EMBASE, MEDLINE, and the Cochrane Library were systematically searched from their inception to August 2020. The quality of evidence for variables used in the meta-analysis was determined using the GRADE system. Five studies satisfied the criteria for data analysis. All studies included individuals without any spinal symptoms. Data from five studies on neck angle showed a statistically significant (p = 0.02) overall effect (standardized mean difference (SMD) = 0.77), indicating a lesser neck flexion angle while sitting with a lumbar roll than without it. Data from two studies on head angle showed a statistically significant (p = 0.04) overall effect (SMD = 0.47), indicating a lesser head extension angle while sitting with a lumbar roll than without it. In each meta-analysis, the quality of evidence was very low in the GRADE system. The use of a lumbar roll while sitting reduced FHP among individuals without spinal symptoms.

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Association between serum visfatin levels and psoriasis and their correlation with disease severity: a meta-analysis

Journal of International Medical Research ◽

10.1177/03000605211002381 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110023

Author(s):

Qian Zou ◽

Jiawei Si ◽

Yatao Guo ◽

Jiayu Yu ◽

Huijuan Shi

Keyword(s):

Body Mass Index ◽

Meta Analysis ◽

Severity Index ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Subgroup Analyses ◽

Mean Differences ◽

The Cochrane Library ◽

Psoriasis Severity

Objective To determine the association between serum visfatin levels and psoriasis and to evaluate the correlation between serum visfatin levels and the severity of psoriasis. Methods The electronic databases PubMed®, Embase® and the Cochrane Library were searched for articles published from inception to 1 May 2020. Data were extracted and then standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pooled estimates. Results A total of 11 studies met the inclusion criteria and were included (448 patients diagnosed with psoriasis and 377 controls). This meta-analysis demonstrated that patients with psoriasis had significantly higher levels of visfatin than the controls (SMD = 0.90, 95% CI 0.52, 1.28). Subgroup analyses showed that differences in serum visfatin levels between the patient group and the control group were associated with ethnicity, Psoriasis Area and Severity Index (PASI) and body mass index. Additionally, a meta-analysis of correlations showed that visfatin levels in patients with psoriasis were positively correlated with PASI ( r = 0.51, 95% CI 0.14, 0.75). Conclusions This meta-analysis showed that serum visfatin levels in patients with psoriasis were significantly higher than those in the controls and a positive correlation between serum visfatin levels and psoriasis severity was observed.

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