Perda de peso e mortalidade em pessoas vivendo com HIV: revisão sistemática e metanálise

Abstract

Introduction: In the first reported human immunodeficiency virus (HIV) infection cases, people living with HIV (PLHIV) experienced weight loss, which was an independent predictor of mortality. Highly active antiretroviral therapy (HAART) has changed this scenario to ideal weight, overweight, and even obesity. However, some PLHIV, even on HAART, continues to lose weight. Thus, the guiding question of the study was: Do hospitalized PLHIV on HAART with weight loss have higher mortality than hospitalized PLHIV on HAART without weight loss? Method: Systematic review and meta-analysis of observational studies conducted according to the guidelines for Meta-Analysis of Observational Studies in Epidemiology (MOOSE). The literature search was conducted in MEDLINE via PubMed, Embase, and LILACS databases. The project was registered in the International Prospective Register of Systematic Reviews (CRD42020191246) and published in Principles and Practice of Clinical Research. The study identification process was carried out by three reviewers independently and segmented into phases: Identification, Screening, and Inclusion. Analysis of methodological quality and risk of bias was performed with the Joanna Briggs Institute critical appraisal tool for cohort studies, and heterogeneity between studies was assessed by Higgins and Thompson's I² test. The random-effect model was used to analyze the included studies, and the funnel plot was used to assess publication bias. The inverse variance test estimated by the Mantel-Haenszel method with 95% confidence interval was used for the meta-analysis. Influence diagnostics and identification of outliers, analysis by meta-regression, and meta-analysis in subgroups were performed in a sensitivity analysis. Results: Ten studies were included for the qualitative and quantitative analysis, with 1,637 PLHIV analyzed. The prevalence of death in hospitalized PLHIV on HAART who lost weight was 57.5%, with a 1.5 risk of dying (RR: 1.50, 95% CI: 1.03, 2.19, p=0.04) than hospitalized PLHIV who did not lose weight. Conclusion: Hospitalized PLHIV on HAART with weight loss have a higher risk of dying than those without weight loss.