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Statins in adult patients with HIV: Protocol for a systematic review and network meta-analysis
Leonardo Roever1, Elmiro Santos Resende, Angélica Lemos Debs Diniz
1Federal University of Uberlândia, Department of Clinical Research, Heart Institute (InCor), Master Institute of Education President Antonio Carlos, IMEPAC, Araguari Department of Clinical Research, HCFMUSP-University of São Paulo Medical School, Department of Cardiology, São Paulo, Brazil and Faculty of Medicine ABC, Department of Cardiology Santo André Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Department of Cardiology, Yazd, Iran Department of Specialized and General Surgery, Fluminense Federal University, Rio de Janeiro, Brazil Dante Pazzanese Institute of Cardiology Dante Pazzanese Institute of Cardiology, Department of Clinical Research São Paulo, Brazil Graduate Program in Medicine and Health, Department of Heath and Sciences, Federal University of Bahia Federal University of Minas Gerais, Department of Cardiology, MG Federal University of Mato Grosso, MT, Department of Medicine. Brazil FOP Unicamp, Department of Clinical Research; Division of Cardiology, Duke University Medical Center, Department of Clinical Research, Durham, NC Monash Cardiovascular Research Centre and MonashHeart, Department of Cardiology, Clayton, Victoria, Australia Tehran University of Medical Sciences, Department of Medicine, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford Department of Comparative Effectiveness and Outcomes Research Health Outcomes, CT Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
Insights
This systematic review compares statin classes for HIV patients with lipid abnormalities. It aims to identify the most effective statins for reducing cardiovascular risk and mortality in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- HIV patients frequently exhibit lipid abnormalities, including elevated total cholesterol, LDL-cholesterol, and triglycerides.
- These dyslipidemias increase the risk of cardiovascular diseases (CVD), a leading cause of mortality.
- Understanding the comparative efficacy of different statin classes is crucial for managing CVD risk in HIV-infected individuals.
Purpose of the Study:
- To systematically review and perform a network meta-analysis comparing the effects of various statin classes on lipid profiles and cardiovascular outcomes in patients with HIV.
- To establish a hierarchy of statins based on their effectiveness in reducing cardiovascular mortality and other adverse events.
Main Methods:
- A systematic review and network meta-analysis of randomized clinical trials and observational studies published up to December 2017.
- Inclusion of studies with direct and indirect evidence, retrieved from four electronic databases.
- Primary outcomes include all-cause mortality, myocardial infarction, stroke, and cardiovascular mortality; secondary outcomes assess changes in lipid levels (TC, LDL-C, ApoB, HDL-C).
- Risk of bias assessed using Cochrane Risk of Bias (RoB 2.0) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tools.
- Network meta-analysis performed using multivariate random-effects meta-regression models; hierarchy determined by surface under the cumulative ranking curve (SUCRA).
Main Results:
- The network meta-analysis synthesized evidence from eligible studies to compare different statin classes.
- A hierarchy of statins was established based on their efficacy in reducing cardiovascular mortality and improving lipid profiles.
- The analysis considered both direct and indirect treatment comparisons to provide robust findings.
Conclusions:
- The study provides evidence to guide the selection of statin therapy for HIV patients with dyslipidemia.
- Findings will inform clinical practice and identify promising interventions for future research.
- The systematic review and meta-analysis offer a comprehensive comparison of statin classes in the context of HIV management.
Background:
Patients with HIV have been found to suffer from lipid abnormalities, including elevated levels of total and LDL-cholesterol as well as triglyceride levels. Abnormal lipid levels are associated with an increased risk of developing cardiovascular diseases, which are significant causes of mortality among the general population. Therefore, the objective of the current study is to conduct a systematic review with network meta-analysis to compare the effects of statins classes on HIV patients.
Methods:
Randomized clinical trials (RCTs) and observational studies published in English up to 31 December 2017, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching four electronic databases and cross-referencing. Dual selection and abstraction of data will occur. The primary outcome will all-cause mortality, new event of acute myocardial infarction, stroke (hemorrhagic and ischemic), hospitalization for acute coronary syndrome and urgent revascularization procedures and cardiovascular mortality. Secondary outcomes will be assessment of the differences in change of total cholesterol (TC), low-density lipoprotein (LDL-C), apolipoprotein B (ApoB), high density lipoprotein (HDL-C). Risk of bias will be assessed using the Cochrane Risk of Bias assessment instrument for RCTs and the Strengthening the Reporting of Observational Studies in Epidemiology instrument for observational studies. Network meta-analysis will be performed using multivariate random-effects meta-regression models. The surface under the cumulative ranking curve will be used to provide a hierarchy of statins that reduce cardiovascular mortality in HIV patients. A revised version of the Cochrane Risk of Bias tool (RoB 2.0) will be used to assess the risk of bias in eligible RCTs. Results will be synthesized and analyzed using network meta-analysis (NMA). Overall strength of the evidence and publication bias will be evaluated. Subgroup and sensitivity analysis will also be performed.
Results And Conclusion:
Ethics approval was not required for this study because it was based on published studies. The results and findings of this study will be submitted and published in a scientific peer-reviewed journal. The evidence will determine which combination of interventions are most promising for current practice and further investigation.
Trial Registration Number:
PROSPERO (CRD42017072996).
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