Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis

Background: The widespread use of antiretroviral therapy (ART) has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in...

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Autores principales:	Chunxiang Guo, Yaxin Wu, Yang Zhang, Xinchao Liu, Aixin Li, Meixia Gao, Tong Zhang, Hao Wu, Guanzhi Chen, Xiaojie Huang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	HIV AIDS early infection acute infection primary infection transmitted drug resistance Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/6ee3b353caac44ab820c9c7a30394fba
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spelling	oai:doaj.org-article:6ee3b353caac44ab820c9c7a30394fba2021-11-30T18:19:28ZTransmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis1663-981210.3389/fphar.2021.718763https://doaj.org/article/6ee3b353caac44ab820c9c7a30394fba2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fphar.2021.718763/fullhttps://doaj.org/toc/1663-9812Background: The widespread use of antiretroviral therapy (ART) has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with primary HIV infection (PHI)/AHI/early HIV infection (EHI) and to describe the critical drug-resistant mutations.Methods: We systematically searched the literature between January 1, 2008, and April 30, 2021, in PubMed, Web of Science, Embase, and the Cochrane Library. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE.Results: The data of this meta-analysis come from 12 observational studies, covering 3,558 ART-naive individuals with PHI, AHI, or EHI. The overall prevalence of HIV-TDR is 9.3% (95% CI: 6.8%–11.8%, I2 = 81.1%, in 11 studies). The prevalence of resistance by drug class is the highest for the nonnucleoside reverse transcriptase inhibitors (NNRTIs) at 5.7% (95% CI: 2.9%–8.5%, I2 = 96.6%, in 11 studies), followed by nucleoside reverse transcriptase inhibitors (NRTIs) at 3.4% (95% CI: 1.8%–5.0%, I2 = 86.3%, in 10 studies) and protease inhibitors (PIs) at 3.3% (95% CI: 2.7%–3.9%, I2 = 15.6%, in 10 studies). The prevalence of TDR to integrase inhibitors (INIs) is 0.3% (95% CI: 0.1%–0.7%, I2 = 95.9%, in three studies), which is the lowest among all antiretroviral drugs.Conclusion: The overall prevalence of TDR is at a moderate level among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.Chunxiang GuoYaxin WuYang ZhangYang ZhangXinchao LiuAixin LiMeixia GaoTong ZhangTong ZhangHao WuHao WuGuanzhi ChenXiaojie HuangFrontiers Media S.A.articleHIVAIDSearly infectionacute infectionprimary infectiontransmitted drug resistanceTherapeutics. PharmacologyRM1-950ENFrontiers in Pharmacology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	HIV AIDS early infection acute infection primary infection transmitted drug resistance Therapeutics. Pharmacology RM1-950
spellingShingle	HIV AIDS early infection acute infection primary infection transmitted drug resistance Therapeutics. Pharmacology RM1-950 Chunxiang Guo Yaxin Wu Yang Zhang Yang Zhang Xinchao Liu Aixin Li Meixia Gao Tong Zhang Tong Zhang Hao Wu Hao Wu Guanzhi Chen Xiaojie Huang Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis
description	Background: The widespread use of antiretroviral therapy (ART) has raised concerns about the emergence of HIV transmitted drug resistance (TDR). Acute HIV infection (AHI) was the most appropriate time to detect the spread of TDR. In this meta-analysis, our purpose was to evaluate the level of TDR in ART-naive patients with primary HIV infection (PHI)/AHI/early HIV infection (EHI) and to describe the critical drug-resistant mutations.Methods: We systematically searched the literature between January 1, 2008, and April 30, 2021, in PubMed, Web of Science, Embase, and the Cochrane Library. To evaluate the overall prevalence of TDR, we extracted raw data and analyzed prevalence estimates using Stata SE.Results: The data of this meta-analysis come from 12 observational studies, covering 3,558 ART-naive individuals with PHI, AHI, or EHI. The overall prevalence of HIV-TDR is 9.3% (95% CI: 6.8%–11.8%, I2 = 81.1%, in 11 studies). The prevalence of resistance by drug class is the highest for the nonnucleoside reverse transcriptase inhibitors (NNRTIs) at 5.7% (95% CI: 2.9%–8.5%, I2 = 96.6%, in 11 studies), followed by nucleoside reverse transcriptase inhibitors (NRTIs) at 3.4% (95% CI: 1.8%–5.0%, I2 = 86.3%, in 10 studies) and protease inhibitors (PIs) at 3.3% (95% CI: 2.7%–3.9%, I2 = 15.6%, in 10 studies). The prevalence of TDR to integrase inhibitors (INIs) is 0.3% (95% CI: 0.1%–0.7%, I2 = 95.9%, in three studies), which is the lowest among all antiretroviral drugs.Conclusion: The overall prevalence of TDR is at a moderate level among AHI patients who have never received ART. This emphasizes the importance of baseline drug resistance testing for public health surveillance and guiding the choice of ART. In addition, the prevalence of TDR to NNRTIs is the highest, while the TDR to INIs is the lowest. This may guide the selection of clinical antiretroviral drugs.
format	article
author	Chunxiang Guo Yaxin Wu Yang Zhang Yang Zhang Xinchao Liu Aixin Li Meixia Gao Tong Zhang Tong Zhang Hao Wu Hao Wu Guanzhi Chen Xiaojie Huang
author_facet	Chunxiang Guo Yaxin Wu Yang Zhang Yang Zhang Xinchao Liu Aixin Li Meixia Gao Tong Zhang Tong Zhang Hao Wu Hao Wu Guanzhi Chen Xiaojie Huang
author_sort	Chunxiang Guo
title	Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis
title_short	Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis
title_full	Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis
title_fullStr	Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis
title_full_unstemmed	Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis
title_sort	transmitted drug resistance in antiretroviral therapy-naive persons with acute/early/primary hiv infection: a systematic review and meta-analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/6ee3b353caac44ab820c9c7a30394fba
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Transmitted Drug Resistance in Antiretroviral Therapy-Naive Persons With Acute/Early/Primary HIV Infection: A Systematic Review and Meta-Analysis

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