RESUMO
Objective: The risk of falls in people living with HIV (PLHIVs) on antiretroviral therapy (ART) has received little attention in the literature. The aim of the meta-analysis is to quantify the association between fall risk and various categories of drugs used in ART. Material and Methods: PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Any observational study or controlled trial that reported on the relationship of at least one antiretroviral drug with falls in PLHIVs was included. Data on the frequency of single fallers, multiple fallers (≥2 falls), and non-fallers were extracted and studied for each drug and drug category. The pooled results were reported as an odds ratio (OR) with a 95% confidence interval (CI). Results: A total of five observational studies (51 675 participants) were included out of 414 articles obtained through a literature review. Stavudine use was found to be associated with an increased risk of single falls in PLHIVs (OR: 1.69, 95% CI: 1.08-2.66, P=0.02). However, efavirenz (OR: 0.82, 95% CI=0.76-0.89, P<0.001) and zidovudine (OR: 0.82, 95% CI=0.77-0.92, P<0.001) were found protective against the single falls. Didanosine had no significant association with fall risk (OR: 1.23, 95% CI: 0.78-1.93, P=0.37). Likewise, protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors were discovered to have no significant association with fall risk. Conclusion: Most drug categories of ART have no significant association with the risk of falls in PLHIVs. However, certain drugs, such as didanosine and stavudine, which have the inherent effect of causing balance deficits and neuropathy, should be used cautiously.
RESUMO
INTRODUCTION: Most countries in South Asia are endemic for rheumatic heart disease (RHD). We aimed to estimate the pooled prevalence of RHD in South Asia from population-based screening studies. METHODS: A systematic strategy was developed and used to search online databases for articles which described the prevalence of RHD in the South Asia region. Articles published in the English language between 1991 and 2021 were included in the review after fulfilling eligibility criteria. RESULTS: The pooled prevalence of RHD in South Asia was 2.79 per 1000 (95% Confidence interval (CI): 1.30-4.83) according to studies using auscultation followed by echocardiography of suspected cases and 18.28 per 1000 (95% CI: 11.59-26.44) for studies using echocardiography screening of all participants. The highest prevalence of 8.0 per 1000 (95% CI: 0.71-22.74) was observed in Pakistan, whereas the lowest prevalence of 0.32 per 1000 (95% CI: 0.18-0.48) was observed in Bangladesh. The prevalence of RHD has decreased to 2.30 per 1000 from 3.06 per 1000 by 24.84% in 30 years (1991-2021). The prevalence is more than twice higher using WHF criteria compared to WHO criteria. We observed no sex-related differences in prevalence (p = 0.16). CONCLUSIONS: The prevalence of RHD is still high in the South Asian population. Recent studies utilizing echocardiographic screening have identified subclinical cases of RHD, reflecting the significant burden of the disease in this region. More population-based echocardiography screening studies in every country in South Asia are required to estimate the accurate prevalence of the disease.