4.7 Review

Pre-treatment HIV-1 drug resistance in antiretroviral therapy-naive adults in Eastern Africa: a systematic review and meta-analysis

Journal

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Volume 77, Issue 12, Pages 3231-3241

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/jac/dkac338

Keywords

-

Funding

  1. Consortium for Advanced Research Training in Africa (CARTA)
  2. Carnegie Corporation of New York [G-19-57145]
  3. Sida [54100113]
  4. Uppsala Monitoring Centre
  5. DELTAS Africa Initiative [107768/Z/15/Z]
  6. New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency)
  7. Wellcome Trust (UK)
  8. UK government

Ask authors/readers for more resources

This study found a moderate overall PDR prevalence among adults newly initiating ART in Eastern Africa, with NNRTI-related PDR being more prevalent, underscoring the importance of the current WHO recommendation for replacement of NNRTIs by INSTIs, and low but notable PDR to NRTIs requiring continuous surveillance.
Background Pre-treatment HIV drug resistance (PDR) may result in increased risk of virological failure and acquisition of new resistance mutations. With recently increasing ART coverage and periodic modifications of the guidelines for HIV treatment, there is a need for an updated systematic review to assess the levels of the PDR among adults newly initiating ART in Eastern Africa. Methods We conducted a systematic search for studies published between 1 January 2017 and 30 April 2022 in the MEDLINE Complete and CINAHL Complete, searched simultaneously using EBSCOhost, and Web of Science. To determine the overall PDR prevalence estimates, we extracted data from eligible articles and analysed prevalence estimates using Stata 14.2. Results A total of 22 eligible observation studies were selected. The studies included a total of 5852 ART-naive people living with HIV. The overall pooled prevalence of PDR was 10.0% (95% CI: 7.9%-12.0%, I-2 = 88.9%) and 9.4% (95% CI: 7.0%-11.9%, I-2 = 90.4%) for NNRTIs, 2.6% (95% CI: 1.8%-3.4%, I-2 = 69.2%) for NRTIs and 0.7% (95% CI: 0.3%-1.2%, I-2 = 29.0%) for PIs. No major integrase strand transfer inhibitors (INSTI)-related mutations were identified. Conclusions We observed a moderate overall PDR prevalence among new ART initiators in this study. PDR to NNRTIs is more prevalent, underscoring the importance of the current WHO recommendation for replacement of NNRTIs by INSTIs. PDR to NRTIs was low but notable, which warrants continuous surveillance of pre-existing resistance to the dolutegravir co-administered NRTI in Eastern Africa.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available