Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Đánh giá tổng hợp về tác động của liệu pháp kháng virus đối với kết quả nhận thức thần kinh ở người lớn sống với HIV-1 tại các quốc gia có thu nhập thấp và trung bình
Tóm tắt
Suy giảm nhận thức thần kinh liên quan đến HIV vẫn là một thách thức ngay cả trong thời kỳ liệu pháp kháng virus (ART). Hơn 90% người sống với HIV đang sinh sống ở các quốc gia có thu nhập thấp và trung bình. Vì vậy, không có gì ngạc nhiên khi những quốc gia này phải gánh chịu một gánh nặng đáng kể về các bệnh đồng mắc như suy giảm nhận thức thần kinh liên quan đến HIV dù tuổi thọ trung bình đã tăng lên. Tài liệu cho thấy có sự khác biệt về đặc điểm bệnh nhân, hồ sơ lâm sàng, các kiểu HIV phổ biến, sự lựa chọn điều trị, dược động học và yếu tố kinh tế xã hội giữa các quốc gia có thu nhập thấp và trung bình so với các quốc gia có thu nhập cao. Do đó, chúng tôi đặt ra mục tiêu đánh giá tác động của ART đối với kết quả nhận thức thần kinh tại các quốc gia có thu nhập thấp và trung bình. Một tìm kiếm toàn diện năm cơ sở dữ liệu (PubMed, CINAHL, CENTRAL, PsychInfo, Google học thuật) đã được thực hiện để xác định các nghiên cứu công bố từ năm 1996 đến 2020 báo cáo kết quả nhận thức thần kinh ở những người dương tính với HIV được điều trị bằng ART và không được điều trị. Hai người đánh giá độc lập đã tiến hành sàng lọc nghiên cứu, trích xuất dữ liệu và đánh giá nguy cơ sai lệch. Ước lượng kích thước hiệu ứng tổng hợp (Hedges' g) và khoảng tin cậy 95% (CI) đã được tính toán bằng cách sử dụng mô hình hiệu ứng ngẫu nhiên. Phân tích độ nhạy, phân tích nhóm, hồi quy meta và đánh giá thiên kiến công bố cũng đã được thực hiện. Bốn mươi nghiên cứu (24 nghiên cứu cắt ngang, 13 nghiên cứu theo chiều dọc và hai thử nghiệm kiểm soát ngẫu nhiên) đã góp phần vào một loạt các phân tích meta. Chúng tôi nhận thấy tác động nhỏ đến trung bình có ý nghĩa của liệu pháp kháng virus đối với nhận thức toàn cầu (Hedges’ g quan sát được = 0.30; 95% CI: 0.15, 0.44; k = 25; p = 0.0003; I2 = 92.1%; tau = 0.32; Q = 305.1), chức năng điều hành (Hedges’ g = 0.24, 95%CI: 0.02, 0.46; p = 0.04; k = 8; I2 = 37.5%; tau = 0.23; Q = 11.2), và tốc độ xử lý thông tin (Hedges’ g = 0.25, 95% CI: 0.05, 0.45; k = 9; p = 0.02; I2 = 86.4%; tau = 0.21; Q = 58.9). Chúng tôi không thấy tác động ART có ý nghĩa đối với sự chú ý - trí nhớ làm việc, học tập và trí nhớ, chức năng vận động và lưu loát ngôn ngữ. Không thấy tác động có ý nghĩa với thời gian điều trị, việc sử dụng efavirenz và Hiệu quả Penetrating Trung tâm (CPE) của liệu pháp kháng virus. Các phân tích nhóm xác định thiết kế nghiên cứu (giữa nhóm và trong nhóm; cắt ngang và theo chiều dọc) và điểm số chuẩn hóa là những nguồn khác biệt quan trọng. Phân tích hồi quy meta chỉ ra rằng nadir CD4 đã điều chỉnh cường độ tác động của ART đối với kết quả nhận thức. Tuổi tác, giới tính và nhóm thu nhập quốc gia không phải là các yếu tố sửa đổi có ý nghĩa. Các phát hiện của chúng tôi cung cấp chứng cứ hệ thống rằng liệu pháp kháng virus cải thiện kết quả nhận thức thần kinh trong các lĩnh vực nhận thức toàn cầu, chức năng điều hành và tốc độ xử lý thông tin của những người sống với HIV ở các quốc gia có thu nhập thấp và trung bình, đặc biệt là những người có suy giảm miễn dịch nặng. Tuy nhiên, các phát hiện này không phải là kết luận cuối cùng do bị giới hạn bởi khả năng thiên kiến công bố, sự khác biệt cao và loại trừ các yếu tố gây nhiễu quan trọng. Số đăng ký Prospero: CRD42020203791.
Từ khóa
#HIV #liệu pháp kháng virus #suy giảm nhận thức thần kinh #các quốc gia có thu nhập thấp và trung bình #nghiên cứu metaTài liệu tham khảo
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