title: Comparative effectiveness of tenofovir in treatment-naïve HIV-infected patients: systematic review and meta-analysis.
abstract: BACKGROUND
  Benefits and harms of tenofovir disoproxil fumarate (TDF) in HIV-infected, antiretroviral treatment (ART)-naïve patients of any age have not been systematically reviewed since recent milestone trials were published.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CENTRAL, SCI, LILACS, WHO GHL, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing TDF-based treatments with any other ART-regimen (last search 01/2015). Trial characteristics and results were extracted, risks of bias systematically assessed, and treatment effects synthesized in meta-analyses using random-effects models.
  
  
  RESULTS
  We included 22 RCTs (8297 patients). We found no differences between groups for mortality, AIDS, fractures, CD4 cell count, and virological failure; and inconclusive information due to inadequate reporting for cardiovascular events, renal failure, proteinuria, rash, and quality of life. Tenofovir disoproxil fumarate-based regimens significantly reduced total cholesterol (mean difference -18.42 mg/dl; 95% confidence interval [CI] -22.80 to -14.0), LDL-cholesterol (-9.53 mg/dl; -12.16 to -6.89), HDL-cholesterol (-2.97 mg/dl; -4.41 to -1.53), and triglycerides (-29.77 mg/dl; -38.61 to -20.92), bone mineral density (BMD) (hip: -1.41%; -1.87 to -0.94), and glomerular filtration rate (eGFR) (-3.47 ml/minute; -5.89 to -1.06) over 48 weeks of follow-up. Effects were similar in trials comparing fixed-dose TDF/FTC-based regimens with ABC/3TC-based regimens. We found no influence of baseline viral load on virological failure.
  
  
  CONCLUSIONS
  Moderate-quality evidence suggests similar effects of TDF-based treatment regimens and other ART on virological failure. Tenofovir disoproxil fumarate-based regimens are associated with a more favorable lipid profile, but with increased risk of reduced BMD and eGFR. Improved reporting quality is vital to allow assessment of clinical outcomes in future trials.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Hemkens
authors.forename: Hannah
authors.initials: H
authors.lastname: Ewald
authors.forename: Marilia
authors.initials: M
authors.lastname: Santini-Oliveira
authors.forename: Julian-Emanuel
authors.initials: JE
authors.lastname: Bühler
authors.forename: Danielle
authors.initials: D
authors.lastname: Vuichard
authors.forename: Stefan
authors.initials: S
authors.lastname: Schandelmaier
authors.forename: Marcel
authors.initials: M
authors.lastname: Stöckle
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008055:Lipids / Q000097:blood; D000068698:Tenofovir / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D008055:Lipids; D000068698:Tenofovir
keywords: Antiretroviral naïve,; HIV,; Meta-analysis; Tenofovir,