Effect of ART on Cytokine Profile amongst HIV Patients: A Systematic Review and Meta-Analysis
Introduction: The contribution of cytokines released during HIV infection to immune activation and viral replication cannot be overemphasized. Imbalance in cytokine release could be responsible for the immune deregulation that eventually degenerates to Acquired Immunodeficiency Syndrome (AIDS). Currently, no clearly defined pattern of the influence of antiretroviral therapy (ART) on cytokine profiles has been identified. While some research works report a pro-inflammatory influence of ART, others illustrate otherwise. These disparities necessitate a review of the effect of ART on cytokine profiles of HIV-positive patients.
Methods: Studies describing cytokine profiles among HIV-infected cases or cohorts without severe AIDS or several comorbidities (from 2010-2020) were carefully inspected from various databases, including; Google Scholar, PubMed, Science Direct, CINAHL, and Scopus, for material relevant to our review. Meta-analyses were performed using STATA 16.1 for Windows. Heterogeneity between studies was assessed using the I2 test. SMD was used as a summary statistic.
Results: 805 research articles were initially identified. However, when scrutinized, 777 were excluded since they failed to meet the selection criteria. Overall, 28 studies were selected for final review. A total of 382 individuals from 4 studies were included in the meta-analysis. The results suggested TNF-α and IL-6 were significantly higher in patients on ART than in healthy/HIV controls, the SMD and 95% confidence interval (CI) was 1.34 (0.13, 2.55), and 1.56 (1.15, 1.98), respectively.
Conclusions: HAART stimulates the production of pro-inflammatory cytokines (significantly IL-6 and TNF-α) when viral load is high. However, the pro-inflammatory cytokines decline towards normalcy when HAART is effective in reducing viral load. More studies are needed to evaluate these cytokines as potential biomarkers of treatment response and therapy failure.
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