@article{Zhao9000,
abstract = {Background: Integrase strand transfer inhibitors (InSTIs) decrease HIV plasma viral load faster than other antiretroviral classes. More rapid viral load decline has been associated with higher risk of immune reconstitution inflammatory syndrome (IRIS). There are conflicting reports on the association between InSTI and IRIS. We performed a systematic review and meta-analysis to compare the risk of IRIS among treatment-na{\"{i}}ve HIV-positive patients starting InSTI versus non-InSTI regimens. Methods: We searched PubMed, Scopus, Web of Science, Africa-Wide, and Cochrane databases from earliest available date to 26 November 2021, for randomised controlled trials (RCTs) having intervention arms with InSTI versus control arms without InSTI in patients initiating first-line antiretroviral therapy. The primary outcome was relative risk (RR) of IRIS, while the secondary outcome was RR of paradoxical tuberculosis-associated IRIS (TB-IRIS). Data were combined by random-effects meta-analysis according to the Mantel-Haenszel method. The protocol for this study is registered with PROSPERO, CRD42020213976. Results: We included 14 RCTs comprising 8696 participants from six continents for the primary outcome of IRIS, and a subset of 674 participants (from three RCTs) for the secondary outcome of paradoxical TB-IRIS. Risk of IRIS was similar between InSTI and non-InSTI regimens (RR, 0.93, 95{\%} confidence interval [CI], 0.75 – 1.14). There was a trend towards a lower risk of paradoxical TB-IRIS with InSTI versus efavirenz regimens that was not statistically significant (RR, 0.64, 95{\%} CI, 0.34 – 1.19). Conclusions: In this meta-analysis among treatment-na{\"{i}}ve patients commencing first-line antiretroviral therapy, InSTI regimens were not associated with higher risk of IRIS. Corresponding author Dr Ying Zhao Room N2.09, Werner Beit North, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Email: zhxyin001@myuct.ac.za Conflicts of Interest and Sources of Funding: This work was supported by the Wellcome Trust through core funding from the Wellcome Centre for Infectious Diseases Research in Africa (203135/Z/16/Z). GrM was supported by the Wellcome Trust (214321/Z/18/Z) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 64787). M.E.E. was supported by grant (NW17SFRN33630027) from the, American Heart Association. The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone. The authors have no conflicts of interest to disclose. * Contributed equally to this manuscript Copyright {\textcopyright} 2022 Wolters Kluwer Health, Inc. All rights reserved.},
author = {Zhao, Ying and Hohlfeld, Ameer and Namale, Phiona and Meintjes, Graeme and Maartens, Gary and Engel, Mark E},
doi = {10.1097/QAI.0000000000002937},
issn = {1525-4135},
journal = {Journal of Acquired Immune Deficiency Syndromes},
keywords = {Antiretroviral therapy,HIV,immune reconstitution inflammatory syndrome,integrase inhibitors,review},
mendeley-tags = {review},
title = {{Risk of immune reconstitution inflammatory syndrome with integrase inhibitors versus other classes of antiretrovirals: a systematic review and meta-analysis of randomised trials}},
url = {https://journals.lww.com/jaids/Fulltext/9000/Risk{\_}of{\_}immune{\_}reconstitution{\_}inflammatory.95690.aspx},
year = {2022}
}

{"_id":"eqoprb8bPmaMvJDZr","bibbaseid":"zhao-hohlfeld-namale-meintjes-maartens-engel-riskofimmunereconstitutioninflammatorysyndromewithintegraseinhibitorsversusotherclassesofantiretroviralsasystematicreviewandmetaanalysisofrandomisedtrials-2022","author_short":["Zhao, Y.","Hohlfeld, A.","Namale, P.","Meintjes, G.","Maartens, G.","Engel, M. E"],"bibdata":{"bibtype":"article","type":"article","abstract":"Background: Integrase strand transfer inhibitors (InSTIs) decrease HIV plasma viral load faster than other antiretroviral classes. More rapid viral load decline has been associated with higher risk of immune reconstitution inflammatory syndrome (IRIS). There are conflicting reports on the association between InSTI and IRIS. We performed a systematic review and meta-analysis to compare the risk of IRIS among treatment-naïve HIV-positive patients starting InSTI versus non-InSTI regimens. Methods: We searched PubMed, Scopus, Web of Science, Africa-Wide, and Cochrane databases from earliest available date to 26 November 2021, for randomised controlled trials (RCTs) having intervention arms with InSTI versus control arms without InSTI in patients initiating first-line antiretroviral therapy. The primary outcome was relative risk (RR) of IRIS, while the secondary outcome was RR of paradoxical tuberculosis-associated IRIS (TB-IRIS). Data were combined by random-effects meta-analysis according to the Mantel-Haenszel method. The protocol for this study is registered with PROSPERO, CRD42020213976. Results: We included 14 RCTs comprising 8696 participants from six continents for the primary outcome of IRIS, and a subset of 674 participants (from three RCTs) for the secondary outcome of paradoxical TB-IRIS. Risk of IRIS was similar between InSTI and non-InSTI regimens (RR, 0.93, 95% confidence interval [CI], 0.75 – 1.14). There was a trend towards a lower risk of paradoxical TB-IRIS with InSTI versus efavirenz regimens that was not statistically significant (RR, 0.64, 95% CI, 0.34 – 1.19). Conclusions: In this meta-analysis among treatment-naïve patients commencing first-line antiretroviral therapy, InSTI regimens were not associated with higher risk of IRIS. Corresponding author Dr Ying Zhao Room N2.09, Werner Beit North, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Email: zhxyin001@myuct.ac.za Conflicts of Interest and Sources of Funding: This work was supported by the Wellcome Trust through core funding from the Wellcome Centre for Infectious Diseases Research in Africa (203135/Z/16/Z). GrM was supported by the Wellcome Trust (214321/Z/18/Z) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 64787). M.E.E. was supported by grant (NW17SFRN33630027) from the, American Heart Association. The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone. The authors have no conflicts of interest to disclose. * Contributed equally to this manuscript Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.","author":[{"propositions":[],"lastnames":["Zhao"],"firstnames":["Ying"],"suffixes":[]},{"propositions":[],"lastnames":["Hohlfeld"],"firstnames":["Ameer"],"suffixes":[]},{"propositions":[],"lastnames":["Namale"],"firstnames":["Phiona"],"suffixes":[]},{"propositions":[],"lastnames":["Meintjes"],"firstnames":["Graeme"],"suffixes":[]},{"propositions":[],"lastnames":["Maartens"],"firstnames":["Gary"],"suffixes":[]},{"propositions":[],"lastnames":["Engel"],"firstnames":["Mark","E"],"suffixes":[]}],"doi":"10.1097/QAI.0000000000002937","issn":"1525-4135","journal":"Journal of Acquired Immune Deficiency Syndromes","keywords":"Antiretroviral therapy,HIV,immune reconstitution inflammatory syndrome,integrase inhibitors,review","mendeley-tags":"review","title":"Risk of immune reconstitution inflammatory syndrome with integrase inhibitors versus other classes of antiretrovirals: a systematic review and meta-analysis of randomised trials","url":"https://journals.lww.com/jaids/Fulltext/9000/Risk\\_of\\_immune\\_reconstitution\\_inflammatory.95690.aspx","year":"2022","bibtex":"@article{Zhao9000,\r\nabstract = {Background: Integrase strand transfer inhibitors (InSTIs) decrease HIV plasma viral load faster than other antiretroviral classes. More rapid viral load decline has been associated with higher risk of immune reconstitution inflammatory syndrome (IRIS). There are conflicting reports on the association between InSTI and IRIS. We performed a systematic review and meta-analysis to compare the risk of IRIS among treatment-na{\\\"{i}}ve HIV-positive patients starting InSTI versus non-InSTI regimens. Methods: We searched PubMed, Scopus, Web of Science, Africa-Wide, and Cochrane databases from earliest available date to 26 November 2021, for randomised controlled trials (RCTs) having intervention arms with InSTI versus control arms without InSTI in patients initiating first-line antiretroviral therapy. The primary outcome was relative risk (RR) of IRIS, while the secondary outcome was RR of paradoxical tuberculosis-associated IRIS (TB-IRIS). Data were combined by random-effects meta-analysis according to the Mantel-Haenszel method. The protocol for this study is registered with PROSPERO, CRD42020213976. Results: We included 14 RCTs comprising 8696 participants from six continents for the primary outcome of IRIS, and a subset of 674 participants (from three RCTs) for the secondary outcome of paradoxical TB-IRIS. Risk of IRIS was similar between InSTI and non-InSTI regimens (RR, 0.93, 95{\\%} confidence interval [CI], 0.75 – 1.14). There was a trend towards a lower risk of paradoxical TB-IRIS with InSTI versus efavirenz regimens that was not statistically significant (RR, 0.64, 95{\\%} CI, 0.34 – 1.19). Conclusions: In this meta-analysis among treatment-na{\\\"{i}}ve patients commencing first-line antiretroviral therapy, InSTI regimens were not associated with higher risk of IRIS. Corresponding author Dr Ying Zhao Room N2.09, Werner Beit North, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Email: zhxyin001@myuct.ac.za Conflicts of Interest and Sources of Funding: This work was supported by the Wellcome Trust through core funding from the Wellcome Centre for Infectious Diseases Research in Africa (203135/Z/16/Z). GrM was supported by the Wellcome Trust (214321/Z/18/Z) and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa (Grant No 64787). M.E.E. was supported by grant (NW17SFRN33630027) from the, American Heart Association. The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The opinions, findings and conclusions expressed in this manuscript reflect those of the authors alone. The authors have no conflicts of interest to disclose. * Contributed equally to this manuscript Copyright {\\textcopyright} 2022 Wolters Kluwer Health, Inc. All rights reserved.},\r\nauthor = {Zhao, Ying and Hohlfeld, Ameer and Namale, Phiona and Meintjes, Graeme and Maartens, Gary and Engel, Mark E},\r\ndoi = {10.1097/QAI.0000000000002937},\r\nissn = {1525-4135},\r\njournal = {Journal of Acquired Immune Deficiency Syndromes},\r\nkeywords = {Antiretroviral therapy,HIV,immune reconstitution inflammatory syndrome,integrase inhibitors,review},\r\nmendeley-tags = {review},\r\ntitle = {{Risk of immune reconstitution inflammatory syndrome with integrase inhibitors versus other classes of antiretrovirals: a systematic review and meta-analysis of randomised trials}},\r\nurl = {https://journals.lww.com/jaids/Fulltext/9000/Risk{\\_}of{\\_}immune{\\_}reconstitution{\\_}inflammatory.95690.aspx},\r\nyear = {2022}\r\n}\r\n","author_short":["Zhao, Y.","Hohlfeld, A.","Namale, P.","Meintjes, G.","Maartens, G.","Engel, M. 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