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Meta-Analysis
. 2024 Feb 2;24(1):160.
doi: 10.1186/s12879-024-09050-4.

High-sensitivity C-reactive protein among people living with HIV on highly active antiretroviral therapy: a systemic review and meta-analysis

Sihle E Mabhida  1 , Zandile J Mchiza  2   3 , Kabelo Mokgalaboni  4 , Sidney Hanser  5 , Joel Choshi  5 , Haskly Mokoena  5 , Khanyisani Ziqubu  6 , Charity Masilela  7 , Bongani B Nkambule  8 , Duduzile E Ndwandwe  9 , André P Kengne  2   10 , Phiwayinkosi V Dludla  9   7
Affiliations
Meta-Analysis

High-sensitivity C-reactive protein among people living with HIV on highly active antiretroviral therapy: a systemic review and meta-analysis

Sihle E Mabhida et al. BMC Infect Dis. .

Abstract

The pathological consequences of inflammation persist in people living with the human immunodeficiency virus (PLWH), regardless of the positive outcomes of highly active antiretroviral therapy (HAART). The current systematic review and meta-analysis aims to understand and explore the levels of high-sensitivity C-reactive protein (hs-CRP) and other cardiovascular disease (CVD)-risk factors including lipid profiles among PLWH on HAART. Major electronic databases including PubMed, Scopus, and Web of Science were searched to retrieve relevant global literature reporting on hs-CRP levels in PLWH on HAART. A total of twenty-two studies with an average participant age of 40 years were eligible for this systematic review and meta-analysis. Majority of the included studies were from Africa (n = 11), the United States (n = 6), and Europe (n = 5). Our systemic review showed that most studies reported increased levels of hs-CRP among PLWH on HAART when compared to controls (PLWH not on HAART or those without HIV), especially in studies from Africa. This was supported by a meta-analysis showing significantly elevated levels of hs-CRP in PLWH on HAART when compared to PLWH not on HAART (standardised mean difference [SMD] = 0.56; 95% CI = 0.10‑1.01, z = 2.41; p = 0.02) or those without HIV (SMD = 1.19; 95% CI = 0.76‑1.63, z = 5.35; p < 0.001). Where lipid profiles, as a major predictor for CVD risk, were also impaired in PLWH on HAART when compared to PLWH not on HAART and HIV-negative participants. In conclusion, elevated levels of hs-CRP and lipid levels are prevalent in PLWH on HAART, this may increase the risk of CVD complications, especially for those people living in Africa. However, more evidence in larger population studies is required to confirm these outcomes and unveil any possible clinical implications of HAART-induced modulation of hs-CRP levels in PLWH.

Keywords: Cardiovascular disease risk; High-sensitivity C-reactive protein; Highly active antiretroviral therapy; Human immunodeficiency virus; Inflammation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram presents study selection. Briefly, the preliminary search of major electronic databases identified a total of 1009 articles, however only 22 of those were included in the qualitative analysis, and 12 in the meta-analysis
Fig. 2
Fig. 2
A forest plot showing outcomes of a meta-analysis for high sensitivity C-reactive protein (hs-CRP) levels in people living with the human immunodeficiency virus (PLWH) on highly active antiretroviral therapy (HAART), compared to PLWH not on HAART. Green squares represent the weight of each study in the average effect size. Horizontal lines across green squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate
Fig. 3
Fig. 3
A forest plot showing outcomes of a meta-analysis for high sensitivity C-reactive protein (hs-CRP) levels in people living with the human immunodeficiency virus (PLWH) on high active antiretroviral therapy (HAART), compared to HIV-negative controls. Green squares represent the weight of each study in the average effect size. Horizontal lines across green squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate
Fig. 4
Fig. 4
A forest plot shows meta-analysis outcomes for high sensitive C-reactive protein (hs-CRP) levels in people living with the human immunodeficiency virus (PLWH) not on highly active antiretroviral therapy (HAART), compared to HIV-negative controls. Green squares represent the weight of each study in the average effect size. Horizontal lines across green squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate
Fig. 5
Fig. 5
A forest plot showing meta-analysis outcomes for lipid profiles, including high density lipoprotein-cholesterol (HDL-c), low density lipoprotein-cholesterol (LDL-c), total cholesterol (TC) and triglycerides (TG), in people living with the human immunodeficiency virus (PLWH) on highly active antiretroviral therapy (HAART) in comparison to PLWH not on HAART. Green squares represent the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate
Fig. 6
Fig. 6
A forest plot showing outcomes of a meta-analysis for lipid profiles, including high density lipoprotein-cholesterol (HDL-c), low density lipoprotein-cholesterol (LDL-c), total cholesterol (TC) and triglycerides (TG), in people living with the human immunodeficiency virus (PLWH) on highly active antiretroviral therapy (HAART) in comparison to HIV-negative controls. Green squares represent the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate
Fig. 7
Fig. 7
A forest plot showing outcomes of a meta-analysis for lipid profiles, including high density lipoprotein-cholesterol (HDL-c), low density lipoprotein-cholesterol (LDL-c), total cholesterol (TC) and triglycerides (TG), in people living with the human immunodeficiency virus (PLWH) not on highly active antiretroviral therapy (HAART) in comparison to negative controls or individuals without HIV. Green squares represent the weight of each study in the average effect size. Horizontal lines across red squares represent the 95% confidence intervals for the point estimate. The diamonds represent the weighted average point estimate
Fig. 8
Fig. 8
Implication of high-sensitivity C-reactive protein (hs-CRP) and lipid profiles as a potential predictors of cardiovascular disease risk in people living with HIV (PLWH) on highly active antiretroviral therapy (HAART). HIV Human immunodeficiency virus, HDL-c non-high-density lipoprotein cholesterol, TG triglyceride, HDL-c non-high-density lipoprotein cholesterol
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