Interleukin-2 as an adjunct to antiretroviral therapy for HIV-positive adults
Jennifer Onwumeh1, Charles I Okwundu2,3, Tamara Kredo3
1. Faculty of Health Sciences, Stellenbosch University, Community Health Division, Cape Town, South Africa
2. Stellenbosch University, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape Town, South Africa
3. South African Medical Research Council, Cochrane South Africa, Cape Town, South Africa
Onwumeh J, Okwundu CI, Kredo T. Interleukin-2 as an adjunct to antiretroviral therapy for HIV-positive adults. Cochrane Database of Systematic Reviews 2017, Issue 5. Art. No.: CD009818. DOI: 10.1002/14651858.CD009818.pub2
Access the full-text article here: DOI/10.1002/14651858.CD009818.pub2/full
Why did we do this review?
HIV is still a major cause of death worldwide, particularly in Africa. HIV multiplies in the blood and damages the immune system. Therefore if HIV-positive, one is more vulnerable to contract infections. The current drug treatment, antiretroviral therapy (ART), stops the virus from multiplying thereby allowing the body's immune system to recover. Interleukin- 2 (IL-2) is a protein in the body which helps the process of multiplication of white blood cells which are the cells that fight infections. Although IL-2 increases the amount of white cells we do not know if by increasing these we can add additional benefits to the use of ART alone. The aim of this Cochrane Review was to find out if using an extra treatment with antiretroviral therapy (ART), namely IL-2, compared to using ART alone can reduce illness and death in HIV-positive adults.
We found that IL-2 causes an increase in the CD4 immune cells (high certainty evidence). However, there is no difference in important effects such as death and other infections (high certainty evidence). There is probably an increase in side-effects for those people using IL-2 (moderate certainty evidence). Our findings do not support further use of IL-2 as an add-on treatment to ART in HIV-positive adults.
After conducting a comprehensive search on 26 May 2016, we included 25 eligible trials conducted in six countries. There was no difference in the number of deaths between the IL-2 group and those that got ART alone (6 trials, 665 participants, high certainty evidence). Seventeen of 21 trials reported an increase in the CD4 cell count with the use of IL-2 compared to ART alone using different measures. Overall, there was no difference in the proportion of participants with a suppressed viral load of less than 50 cells/mL (5 trials, 805 participants, high certainty evidence) or less than 500 cells/mL by the end of the trials (4 trials, 5029 participants, high certainty evidence). Overall there may be little or no difference in the incidence of opportunistic infections (7 trials, 6141 participants, low certainty evidence). There was probably an increase in grade 3 or 4 adverse events (6 trials, 6291 participants, moderate certainty evidence). None of the included trials reported on adherence.