Systematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole

2.50
Hdl Handle:
http://hdl.handle.net/10757/622484
Title:
Systematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole
Authors:
Connolly, Mark P.; Haitsma, Gertruud; Hernández, Adrián V. ( 0000-0002-9999-4003 ) ; Vidal, José E.
Citation:
Systematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole 2017, 111 (6):327 Pathogens and Global Health
Publisher:
Taylor and Francis Ltd.
Journal:
Pathogens and Global Health
Issue Date:
20-Oct-2017
URI:
http://hdl.handle.net/10757/622484
DOI:
10.1080/20477724.2017.1377974
Additional Links:
https://www.tandfonline.com/doi/full/10.1080/20477724.2017.1377974
Abstract:
A recent systematic literature and meta-analysis reported relative efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of toxoplasmic encephalitis (TE) in HIV-infected adults. Here, we estimated relapse rates during secondary prophylaxis with TMP-SMX, and further explored differences in relapse rates prior to introduction of highly active antiretroviral therapy (HAART) and the widespread adoption of HAART. A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials yielded 707 studies whereby 663 were excluded after abstract screening, and 38 were excluded after full review leaving 6 studies for extraction. We performed double data extraction with a third-party adjudicator. Study designs varied with only one randomized study, four prospective cohorts and one retrospective cohort. Relapse rates were transformed using the Freeman-Tukey method and pooled using both fixed-effect and random-effects meta-analysis models. The TMP-SMX relapse rate was 16.4% (95% CI = 6.2% to 30.3%) based on random-effects models. When the disaggregated pre-HAART studies (n = 4) were included, the relapse rate was 14.9% (random effects; 95% CI = 3.7% to 31.9%). Analysis of two post-HAART studies indicated a relapse rate of 19.2% (random effects; 95% CI = 2.8% to 45.6%). Comparing the relapse rates between pre- and post-HAART studies were contrary to what might be expected based on known benefits of HAART therapy in this population. Nevertheless, cautious interpretation is necessary considering the heterogeneity of the included studies and a limited number of subjects receiving TMP-SMX reported in the post-HAART era.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Keywords:
Cerebral toxoplasmosis; HIV; Meta-analysis; Relapse rates; Secondary prevention; Secondary prophylaxis; Toxoplasmic encephalitis; Trimethoprim-sulfamethoxazole
ISSN:
2047-7724; 2047-7732

Full metadata record

DC FieldValue Language
dc.contributor.authorConnolly, Mark P.es
dc.contributor.authorHaitsma, Gertruudes
dc.contributor.authorHernández, Adrián V.es
dc.contributor.authorVidal, José E.es
dc.date.accessioned2018-01-04T15:03:59Z-
dc.date.available2018-01-04T15:03:59Z-
dc.date.issued2017-10-20-
dc.identifier.citationSystematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazole 2017, 111 (6):327 Pathogens and Global Healthes
dc.identifier.issn2047-7724-
dc.identifier.issn2047-7732-
dc.identifier.doi10.1080/20477724.2017.1377974-
dc.identifier.urihttp://hdl.handle.net/10757/622484-
dc.description.abstractA recent systematic literature and meta-analysis reported relative efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) for the treatment of toxoplasmic encephalitis (TE) in HIV-infected adults. Here, we estimated relapse rates during secondary prophylaxis with TMP-SMX, and further explored differences in relapse rates prior to introduction of highly active antiretroviral therapy (HAART) and the widespread adoption of HAART. A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials yielded 707 studies whereby 663 were excluded after abstract screening, and 38 were excluded after full review leaving 6 studies for extraction. We performed double data extraction with a third-party adjudicator. Study designs varied with only one randomized study, four prospective cohorts and one retrospective cohort. Relapse rates were transformed using the Freeman-Tukey method and pooled using both fixed-effect and random-effects meta-analysis models. The TMP-SMX relapse rate was 16.4% (95% CI = 6.2% to 30.3%) based on random-effects models. When the disaggregated pre-HAART studies (n = 4) were included, the relapse rate was 14.9% (random effects; 95% CI = 3.7% to 31.9%). Analysis of two post-HAART studies indicated a relapse rate of 19.2% (random effects; 95% CI = 2.8% to 45.6%). Comparing the relapse rates between pre- and post-HAART studies were contrary to what might be expected based on known benefits of HAART therapy in this population. Nevertheless, cautious interpretation is necessary considering the heterogeneity of the included studies and a limited number of subjects receiving TMP-SMX reported in the post-HAART era.es
dc.formatapplication/pdfes
dc.language.isoenges
dc.publisherTaylor and Francis Ltd.es
dc.relation.urlhttps://www.tandfonline.com/doi/full/10.1080/20477724.2017.1377974es
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.subjectCerebral toxoplasmosises
dc.subjectHIVes
dc.subjectMeta-analysises
dc.subjectRelapse rateses
dc.subjectSecondary preventiones
dc.subjectSecondary prophylaxises
dc.subjectToxoplasmic encephalitises
dc.subjectTrimethoprim-sulfamethoxazolees
dc.titleSystematic review and meta-analysis of secondary prophylaxis for prevention of HIV-related toxoplasmic encephalitis relapse using trimethoprim-sulfamethoxazolees
dc.typeinfo:eu-repo/semantics/articlees
dc.identifier.journalPathogens and Global Healthes
dc.contributor.institutionUnit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands-
dc.contributor.institutionUnit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands-
dc.contributor.institutionUCONN Evidence-based Practice Center, Hartford Hospital, Hartford, USA-
dc.contributor.institutionDepartment of Neurology, Emílio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil-
dc.description.peerreviewRevisión por pareses_PE
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