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Efficacy, effectiveness, and safety of integrase inhibitors in the treatment of HIV/AIDS in patients with tuberculosis: A systematic review and meta-analysis

Aims: To evaluate the efficacy, effectiveness, and safety of integrase
inhibitors in the treatment of HIV/AIDS in patients coinfected with
tuberculosis (TB). Methods: Clinical trials or observational studies
were included. The searches were performed in the MEDLINE, EMBASE,
LILACS, COCHRANE, Web of Science, Scopus, and CINAHL databases using the
terms “HIV”, “AIDS”, “tuberculosis”, “raltegravir potassium”,
“dolutegravir”, “elvitegravir”, “bictegravir”, “integrase
inhibitor”, and their respective synonyms. The methodological quality
of the studies was independently assessed using the Cochrane risk of
bias and Newcastle Ottawa scales. Results: Reports from three randomised
clinical trials and a historical cohort were included. Patients
coinfected with TB and HIV/AIDS showed a good response to TB treatment,
which was above 85% in all arms of the evaluated studies. As a primary
outcome, the HIV viral load suppression rates at week 48 were greater
than 60% in all arms. The therapies evaluated in patients coinfected
with TB and HIV/AIDS were also proven to be safe. However, there was no
statistically significant difference in the efficacy outcomes between
the efavirenz and integrase inhibitor arms, and regarding safety
outcomes, there were few events compared with the total. Furthermore,
the certainty of the evidence of the outcomes assessed was low,
indicating that future research is likely to have an important impact on
this estimate. Conclusion: Integrase inhibitors are effective and well
tolerated, being an alternative to efavirenz in clinical protocols.
However, more studies with high quality evidence are needed on the use
of this treatment in health systems.