Association between frailty phenotype, quantification of plasma HIV-1 RNA, CD4 cell count and HAART in HIV-positive subjects: a systematic review and meta-analysis of observational studies

• Published in: AIDS care Vol. 34; no. 9; pp. 1159 - 1168
• Main Authors: Melo, Géssyca Cavalcante, Carvalho, Aline Carla Araújo, Mendes, Mário Luis Tavares, do Nascimento, Renee Oliveira, de Araújo, Karina Conceição Gomes Machado, Tanajura, Diego Moura, Santos, Victor Santana, Martins-Filho, Paulo Ricardo
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.09.2022; Taylor & Francis Ltd
• Subjects: Aging; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; CD4 antigen; CD4 Lymphocyte Count; Cytokines; Frailty; Heterogeneity; Highly active antiretroviral therapy; HIV; HIV Infections; HIV Seropositivity; HIV-1; Human immunodeficiency virus; Humans; Immune response; Immune system; Inflammation; Lymphocytes; Lymphocytes T; Measurement; Meta-analysis; Observational studies; Phenotype; Phenotypes; Protease inhibitors; Proteinase inhibitors; Ribonucleic acid; RNA; RNA - pharmacology; RNA - therapeutic use; RNA, Viral; Search engines; Systematic review; Viral Load; highly active antiretroviral therapy; Frailty; viral load; HIV; CD4 lymphocyte count
• ISSN: 0954-0121; 1360-0451; 1360-0451
• DOI: 10.1080/09540121.2021.1956414

HIV infection causes a constant activation of the immune system and contributes to an enhanced systemic pro-inflammatory cytokine milieu, which has been associated with premature aging and frailty. We performed a systematic review and meta-analysis to analyze whether the HIV-1 RNA load, CD4+ T-lymphocyte counts and exposure to HAART in HIV-positive subjects are associated with frailty phenotype. Searches were performed in PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar, and OpenThesis databases. We used the odds ratio as a measure of the association. We used either a fixed or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. Eleven studies were included in the review. Data from 8035 HIV-positive subjects were analyzed; 2413 of the subjects had viral load detectable, 981 had a CD4T-cell count <350 cells/μL, and 1342 had HAART exposure information. We found an association between frailty and CD4T-cell count <350 cells/μL (OR 2.68, CI 95% 1.68-4.26, I 2  = 46%), HIV-1 RNA load detectable (OR 1.71, CI 95% 1.38-2.12, I 2  = 0%), and protease inhibitor-containing HAART regimen (OR 2.21, CI 95% 1.26-3.89, I 2  = 0%). Further studies are necessary to evaluate the effects of other factors on the development of clinical features related to frailty.