Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews

Figures & data

Table 1. Search strategy.

	Search term	Number of publications
HIV
1	(HIV or "human immunodeficiency virus").ti,ab or exp HIV/	787,208
Study type
2	1 and ((review* and systematic) or meta-analys* or "meta analysis" or "meta analyses" or "meta review" or "meta-review").ti,ab	11,036
3	2 not animal*.mp	10,849
Outcomes
4	3 and (exp Drug Resistance/ or ((treatment or medication or drug) adj3 (resistance or resistant)).ti,ab)	500
5	3 and ((burden adj2 (pill or drug or treatment or medication or therapy or regimen)) or ((patient or drug or treatment or medication or therapy or regimen) adj2 (complian* or non?complian* or adheren* or non?adheren* or "proportion of days covered" or PDC))).ti,ab	606
6	3 and (comorbid* or weight gain or obesity or bmi or "body mass index" or diabet* or hypertens* or cardiovascular or hyperlipid* or anxiety or depressi* or fatigue or headache or insomnia or dizziness or "poor concentration" or suicid*).ti,ab	1,597
Combinations
7	4 or 5 or 6	2,470
Language and time period
8	limit 7 to (English language and yr = "2017–Current")	1,074
9	remove duplicates from 8	665

Abbreviations: HIV, human immunodeficiency virus; SLR, systematic literature review; US, United States.

Figure 1. PRISMA diagram of study selection.

Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis; SLR, systematic literature review. US, United States.

^aSLRs that included both non-US and US studies, with results at the study level presented (for the US studies), were not excluded.

^bSLRs where the country was not specified overall or at the study level were excluded.

^cOne scoping review included a US study in children aged 7–17 years. It was manually added to include potentially relevant information, despite the study population including children less than 9 years of age.

Figure 2. Main findings related to HIV ART adherence and pill burden, antiretroviral resistance burden, and comorbidity burden.

Abbreviations: AE, adverse event; AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; CVD, cardiovascular disease; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MTR, multiple-tablet regimen; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; PLWH, people living with HIV; STR, single-tablet regimen.

Table 2. Publication details of the included reviews.

Author and Date	Study Type	Type of Studies Included in the SLR (e.g. Retrospective, RCT)	Publication Period Covered in the SLR	Population(s) Included
ART adherence and pill burden
Altice et al. (2019)^9	SLR and meta-analysis	RCTs and observational studies	2006–2016	Individuals receiving STRs or MTRs for HIV treatment
Clay et al. (2018)^16	SLR and meta-analysis	RCTs (single-blind or open-label) and observational studies	2005–2017	Individuals receiving STRs or MTRs for HIV treatment
Diallo et al. (2020)^12	SLR	RCTs, cohort studies, and longitudinal studies	2001–2019	PLWH initiating ART
Pantuzza et al. (2017)^10	SLR	Cross-sectional, prospective, and retrospective (includes observational and experimental designs)	All articles published up until March 2016	Individuals or patients living with HIV and chronic conditions
Uthman et al. (2017)^11	SLR and meta-analysis	Cross-sectional and cohort studies that reported ART adherence rates as primary or secondary outcome	All articles (no publication date restriction was imposed)	Prison inmates living with HIV receiving ART
Antiretroviral resistance burden
Diallo et al. (2020)^12	SLR	RCTs, cohort studies, and longitudinal studies	2001–2019	PLWH initiating ART
Mbunkah et al. (2020)^17	SLR	No explicit inclusion criteria outlined; however, reviews, brief communications, conference proceedings, abstracts, and posters were excluded	All published articles through May 2019	PLWH who are ART-naïve
Vannappagari et al. (2019)^13	SLR and meta-analysis	No explicit exclusion criteria outlined	All published articles through July 2018	PLWH
Comorbidity burden
Bhatta et al. (2020)^14	SLR and meta-analysis	No study type specified	January 2000–December 2018	Elderly population (age restriction: > 50 years)
Biadgo et al. (2019)^18	SLR and meta-analysis	No study type restriction	All studies published up until April 2018	Pregnant women living with HIV
Bigna et al. (2019)^19	SLR and meta-analysis	Cross-sectional, case-control, and cohort studies	All studies published up until 4 November 2015	PLWH (adolescents and adults)
Bigna et al. (2020)^20	SLR and meta-analysis	Cross-sectional, case-control, and cohort studies	January 2007–24 October 2018	PLWH (age restriction: ≥ 18 years)
Chou et al. (2019)^15	SLR	RCTs, cohort studies, and case-control studies	2012–June 2018	PLWH (adolescents [13 to < 18 years] and adults)
Dakum et al. (2019)^21	SLR and meta-analysis	Observational studies	None specified for original search (update search date range: January 2015–25 May 2018)	Elderly PLWH (age restriction: ≥ 50 years old)
Dawood et al. (2020)^22	Scoping review	All study types except reviews, opinions/commentaries, non-peer reviewed articles, any sources of grey literature, and conference proceedings	January 2000 through June 2019	Children living with HIV (≤ 18 years)
Dorjee et al. (2018)^23	SLR and meta-analysis	RCTs, cohort studies, and case-control studies	All studies published up until May 2018	Patients living with HIV receiving abacavir or abacavir-based regimens
Duko et al. (2019)^24	SLR and meta-analysis	Cross-sectional and other observational studies	No publication period restriction	PLWH or AIDS
Echecopar et al. (2018)^25	SLR and meta-analysis	Prospective and retrospective cohort studies, case-control studies, and RCTs	All studies published up until November 2015	PLWH receiving PI treatment (age restriction: ≥ 18 years)
Ekrikpo et al. (2018)^26	SLR and meta-analysis	Observational studies and clinical trials	1982–September 2016	PLWH (age restriction: ≥ 18 years)
Erqou et al. (2019)^27	SLR and meta-analysis	No study type specified	1990–May 2018	PLWH (age restriction: ≥ 15 years old)
Eyawo et al. (2019)^28	SLR and meta-analysis	Observational studies and RCTs	2000–18 July 2018	PLWH (excluding children – no age specified)
Farahani et al. (2017)^29	SLR and meta-analysis	Prospective and retrospective studies	All articles published after 1 January 2005 (study end date required to be after 2005)	PLWH receiving ART
Fialho et al. (2017)^30	SLR and meta-analysis	Prospective and retrospective studies	All articles published up until December 2014	Individuals with HCV, HIV, or HIV/HCV co-infection (age restriction: ≥ 18 years)
Goh et al. (2018)^31	SLR and meta-analysis	Cross-sectional and longitudinal studies	1989–May 2015	PLWH and PLWH who have been treated with either ART, PI, tenofovir (control populations were included for each group; age restriction: ≥ 18 years)
Grand et al. (2020)^32	SLR and meta-analysis	Cross-sectional and longitudinal studies	All articles published up until July 2018	PLWH (age restriction: > 15 years)
Huntingdon et al. (2020)^33	SLR	All study types except reviews, conference proceedings, brief reports, non-peer reviewed work	All articles published since 1997	Male PLWH
Ilha et al. (2018)^34	SLR and meta-analysis	RCTs, cohort studies, cross-sectional studies, and case-control studies	All studies published up until 27 September 2017	PLWH (age restriction: ≥ 18 years)
King et al. (2019)^35	SLR and meta-analysis	Prospective observational studies	No publication period specified	Premenopausal female PLWH
Masenga et al. (2019)^36	SLR	Published articles in peer-reviewed journals	No publication period specified	PLWH (Veterans)
Maurice et al. (2017)^37	SLR and meta-analysis	Prospective and retrospective observational or interventional studies, RCTs, and SLRs	All articles published up until September 2016	Individuals with HIV-monoinfection (age restriction: ≥ 16 years)
Mulè et al. (2020)^55	SLR and meta-analysis	Observational studies	All studies published up until 31 December 2018	PLWH
Nansseu et al. (2018)^38	SLR and meta-analysis	Cohort studies	January 2000–April 2017	PLWH exposed to ART (age restriction: ≥ 18 years)
Olawepo et al. (2020)^39	SLR and meta-analysis	All study types except cross-sectional studies	All articles published through February 2018	Treatment-naïve PLWH (age restriction: ≥ 18 years) who started highly active ART and remained on treatment for at least 6 months
Oliveira et al. (2020)^40	SLR and meta-analysis	Observational studies	All articles published up until 1 August 2019	PLWH (adults – no age specified)
Park et al. (2018)^41	SLR	All study types except SLRs/meta-analyses, reviews or editorials	January 2010–August 2016	PLWH (age restriction: > 21 years)
Pires et al. (2020)^42	SLR	Cross-sectional studies	2006–2018	PLWH
Premkumar et al. (2019)^43	SLR	RCTs and observational studies	January 1997–October 2017	Pregnant PLWH
Rao et al. (2019)^44	SLR and meta-analysis	Longitudinal studies	All articles published prior to January 2017	PLWH (age restriction: ≥ 18 years)
Rezaei et al. (2019)^45	SLR and meta-analysis	Observational studies	January 2000–October 2018	PLWH or AIDS
Shah et al. (2018)^46	SLR and meta-analysis	Longitudinal studies	1948–August 2016	PLWH
Soepnel et al. (2017)^47	SLR and meta-analysis	All study types except for case report studies	All articles published up until October 2015	Pregnant PLWH (no age restriction)
Tao et al. (2018)^48	SLR and meta-analysis	No study type restriction	1996–15 December 2015	PLWH receiving ART
Tsegay et al. (2020)^49	SLR and meta-analysis	All study types except commentaries, reviews, case reports, case series studies, studies done on animals, books, editorials, letters, and conference papers	All published articles up until May 2020	Young PLWH or AIDS (no age specified)
Vancampfort et al. (2017)^50	SLR and meta-analysis	Prospective and cross-sectional studies	All articles published up until 11 May 2016	PLWH or AIDS
Ward et al. (2020)^51	Targeted literature review	No study type specified	January 2012–November 2017	PLWH (US; adults)
Xiao et al. (2020)^52	SLR and meta-analysis	Cross-sectional, case-control, and cohort studies	All studies published through January 2020	Men having sex with men with HIV
Xu et al. (2017)^53	SLR and meta-analysis	Cross-sectional and longitudinal studies	January 2011 through December 2016	PLWH (age restriction: ≥ 16 years)
Zhu et al. (2019)^54	SLR and meta-analysis	No study type restriction	All studies published up until 3 August 2019	Pregnant PLWH

Abbreviations: AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MTR, multi-tablet regimen; PI, protease inhibitor; PLWH, people living with HIV; RCT, randomized controlled trial; SLR, systematic literature review; STR, single-tablet regimen; US, United States.

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Data availability statement

All data included in the study are publicly available or available for purchase through the journal or publisher.