Effect of low dose corticosteroids in HIV disease progression: systematic review

Abstract

Despite the success of antiretroviral therapy on reduction of mortality in HIV infection, HIV-infected patients treated with HAART still have a life expectancy below the average of the uninfected population. Immune activation plays an important role in the pathogenesis of HIV infection. An increasing body of data has clearly demonstrated that, despite ‘undetectable’ viral load levels following initiation of therapy, there remains evidence of persistent immune activation. Objectives:  To establish whether low dose corticosteroids could decrease HIV disease progression. Methods: Electronic searches were undertaken through CENTRAL, CINHAL, Scopus, PubMed, LILACS and Web of Social Science. In addition, we used abstracts from numerous relevant conferences, including the International AIDS Conferences and the annual Conferences on Retroviruses and Opportunistic Infections were searched. We combined data for outcomes from studies that meet the inclusion criteria in the meta-analysis using the latest version of Review Manager Software, provided the studies are sufficiently similar. As all outcomes were continuous data, we used random effects meta-analysis to produce the overall results. JLT and JLT independently assessed the risk of bias for each trial using a simple form and followed the domain-based evaluation as described in the Cochrane Handbook for Systematic Reviews of Intervention. Main results: Thirty eight of 2145 articles were selected and evaluated for their titles and abstracts in relation to the inclusion and exclusion criteria. After duplicate references were eliminated, 9 articles remained and 5 articles were included in meta-analysis. The calculated mean difference of CD4 count (10⁶ cells/ml) between low dose corticosteroids group and control was -117.99 [-230.27, -5.72; p-value= 0.04). The viral load mean difference (10⁴ RNAc/ml) between low dose corticosteroids group and control was 0.77 [-0.01, 1.55; p-value=0.05]. Low dose corticosteroids seems to decrease HIV disease progression with the mean difference of plasma TNF-alpha(pg/ml) at 4 weeks between low dose corticosteroids group and control was -12.65 [-19.75, -5.55; p=0.0005] and -9.72 [-16.61, -2.83; p=0.006] at 8 weeks between . Therefore, low dose corticosteroids did not show any effect on Il-6 within 4 and 8 weeks of intervention. Conclusions: In conclusion, the administration of low dose CSs in HIV-infected patients could not be judged as ameliorating HIV disease progression. In fact, this review included many limitations. However, more RCTs are needed to establish clinical consensus.