Efficacy and safety of Tenofovir-based regimen in elderly people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis
Authors: Akinsolu Folahanmi T. , Ekama Sabdat , Musa Adesola Z. , Oladele David , Ohihion Esther , Ezemelue Priscilla , Adewale Osuolale K. , Davies-Bolorunduro Flora , Chukwu Emelda , Fowora Muinah , Ajibaye Sola , Amoo Sam , Idigbe Ifeoma , Raheem Toyosi , Herbertson Ebiere , Gambari Aisha , Salako Abideen , Olagunju Mobolaji , Gbaja-biamila Titi , Odubela Tosin , Ezeobi Pascal , Okwuzu Jane , David Agatha N. , Odunukwe Nkiruka , Ezebialu Ifeanyichukwu , Eleje George U. , Ezechi Oliver C. 
Published: November 2022

Objective

The study examined whether the benefit and adverse effects of the tenofovir-based highly active antiretroviral therapy (HAART) regimen outweigh the non-tenofovir-based regimen in the elderly population.

Methods

We searched PubMed, EMBASE, Cochrane Central Library, Google Scholar, and some hand searches on September 21, 2021, to identify eligible studies. Only randomized control trials on elderly HIV-positive patients on Tenofovir-based regimens living in sub-Saharan Africa were included. Studies on pregnant women or prophylactic tenofovir were excluded. The primary outcomes are viral suppression, mortality, and anemia. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias. We analyzed using risk ratio, with 95% confidence intervals. A fixed effect model along with an assessment of heterogeneity was done for meta-analysis.

Results

Four studies with a total of 263 participants were included. Our meta-analysis shows that there was no difference between participants on a tenofovir-based regimen and the non-tenofovir-based regimen in terms of viral suppression, mortality, anemia, and hypertension.

Our meta-analysis shows that there was no difference between participants on tenofovir based regimen and non-tenofovir based regimen in terms of viral suppression (RR=1.96, 95% CI (1.42 -2.70; I2=0%, 4 trials, 263 participants, very low certainty of evidence), mortality (RR = 2.90, 95% CI (0.12 – 69.87, I2=Not estimated, a trial, 120 participants, very low certainty of evidence), anaemia (RR=1.61, 95% CI (1.02-2.90; I2= 0.16, 2 trials, 154 participants, very low certainty of evidence), hypertension RR = 0.76, 95% CI (0.44-1.31) I2= Not estimated, a trial, 34 participants, low-certainty of evidence). None of the trials reported the incidence of chronic kidney disease and bone demineralization.

Conclusion

There was very-low certainty evidence that no difference exists between the tenofovir-based HAART regimen and the non-tenofovir-based regimen in terms of benefits and short-term adverse outcomes. Well-designed randomized clinical trials are needed with a focus on long-term adverse effects.

ARTICLE SUMMARY

Strengths and limitations of the study

Tenofovir-based high-active antiretroviral therapy (HAART) is one of the preferred first-line therapies in the management of HIV-1 infection.

The study demonstrates evidence and represents the first comprehensive and up-to-date systematic review and meta-analysis on the effects of the tenofovir-based regimen on elderly patients concerning chronic kidney disease, changes in bone mineral density, number of deaths, viral suppression, hypertension, anemia, and adherence levels of ≥ 95%.

The clinical implications of the study indicate there is an urgent need for evaluation of the effect of long-term use of tenofovir-based regimens among elderly people living with HIV/AIDS due to the paucity of data on the use of tenofovir-based HAART regimens.

The study limitations are the cumulative sample size of the four studies was small with only one study reporting on mortality outcome; there was also a lack of statistical power for the clinical outcomes observed; there was no information on gender disaggregation to consider conducting a sub-group analysis; and there was a great amount of heterogeneity in one of the studies, which was accounted for by using a random effects model but has the same value in a fixed effect model.