Systematic review of the efficacy and safety of antiretroviral drugs against SARS, MERS or COVID-19: initial assessment.
Adult
Anti-Retroviral Agents
/ therapeutic use
Antiretroviral Therapy, Highly Active
Betacoronavirus
COVID-19
Coronavirus
/ drug effects
Coronavirus Infections
/ drug therapy
Drug Combinations
Female
Humans
Lopinavir
Male
Middle Aged
Pandemics
Pneumonia, Viral
/ drug therapy
Ritonavir
Severe acute respiratory syndrome-related coronavirus
/ drug effects
SARS-CoV-2
Severe Acute Respiratory Syndrome
/ drug therapy
COVID-19 Drug Treatment
COVID-19
HIV
MERS
SARS
antiretroviral therapy
coronavirus
Journal
Journal of the International AIDS Society
ISSN: 1758-2652
Titre abrégé: J Int AIDS Soc
Pays: Switzerland
ID NLM: 101478566
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
23
02
2020
revised:
17
03
2020
accepted:
20
03
2020
entrez:
16
4
2020
pubmed:
16
4
2020
medline:
22
4
2020
Statut:
ppublish
Résumé
Several antiretroviral drugs are being considered for the treatment of COVID-19, the disease caused by a newly identified coronavirus, (SARS-CoV-2). We systematically reviewed the clinical outcomes of using antiretroviral drugs for the prevention and treatment of coronaviruses and planned clinical trials. Three databases were screened from inception to 30 March 2020 for studies reporting clinical outcomes of patients with SARS, MERS or COVID-19 treated with antiretrovirals. From an initial screen of 433 titles, two randomized trials and 24 observational studies provided clinical outcome data on the use of antiretroviral drugs; most studies reported outcomes using LPV/r as treatment. Of the 21 observational studies reporting treatment outcomes, there were three studies among patients with SARS, six studies among patients with MERS and 12 studies among patients with COVID-19. In one randomized trial 99 patients with severe COVID-19 illness were randomized to receive LPV/r (400/100 mg twice a day) and 100 patients to standard of care for 14 days: LPV/r was not associated with a statistically significant difference in time to clinical improvement, although LPV/r given within 12 days of symptoms was associated with shorter time to clinical improvement; 28 day mortality was numerically lower in the LPV/r group (14/99) compared to the control group (25/100), but this difference was not statistically significant. The second trial found no benefit. The certainty of the evidence for the randomized trials was low. In the observational studies 3 out of 361 patients who received LPV/r died; the certainty of evidence was very low. Three studies reported a possible protective effect of LPV/r as post-exposure prophylaxis. Again, the certainty of the evidence was very low due to uncertainty due to limited sample size. On the basis of the available evidence it is uncertain whether LPV/r and other antiretrovirals improve clinical outcomes or prevent infection among patients at high risk of acquiring COVID-19.
Identifiants
pubmed: 32293807
doi: 10.1002/jia2.25489
pmc: PMC7158851
doi:
Substances chimiques
Anti-Retroviral Agents
0
Drug Combinations
0
lopinavir-ritonavir drug combination
0
Lopinavir
2494G1JF75
Ritonavir
O3J8G9O825
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25489Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Organisme : Bill and Melinda Gates Foundation
Pays : International
Informations de copyright
© 2020 World Health Organization; licensed by by John Wiley & Sons Ltd on behalf of the International AIDS Society.
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