Global burden of transmitted HIV drug resistance and HIV-exposure categories: a systematic review and meta-analysis.
AIDS
; 28(18): 2751-62, 2014 Nov 28.
Article
em En
| MEDLINE
| ID: mdl-25493601
ABSTRACT
OBJECTIVES:
Our aim was to review the global disparities of transmitted HIV drug resistance (TDR) in antiretroviral-naive MSM, people who inject drugs (PWID) and heterosexual populations in both high-income and low/middle-income countries. DESIGN/METHODS:
We undertook a systematic review of the peer-reviewed English literature on TDR (1999-2013). Random-effects meta-analyses were performed to pool TDR prevalence and compare the odds of TDR across at-risk groups.RESULTS:
A total of 212 studies were included in this review. Areas with greatest TDR prevalence were North America (MSM 13.7%, PWID 9.1%, heterosexuals 10.5%); followed by western Europe (MSM 11.0%, PWID 5.7%, heterosexuals 6.9%) and South America (MSM 8.3%, PWID 13.5%, heterosexuals 7.5%). Our data indicated disproportionately high TDR burdens in MSM in Oceania (Australia 15.5%), eastern Europe/central Asia (10.2%) and east Asia (7.8%). TDR epidemics have stabilized in high-income countries, with a higher prevalence (range 10.9-12.6%) in MSM than in PWID (5.2-8.3%) and heterosexuals (6.4-9.0%) over 1999-2013. In low/middle-income countries, TDR prevalence in all at-risk groups in 2009-2013 almost doubled than that in 2004-2008 (MSM 7.8 vs. 4.2%, Pâ=â0.011; heterosexuals 4.1 vs. 2.6%, Pâ<â0.001; PWID 4.8 vs. 2.4%, Pâ=â0.265, respectively). The risk of TDR infection was significantly greater in MSM than that in heterosexuals and PWID. We observed increasing trends of resistance to non-nucleoside reverse transcriptase and protease inhibitors among MSM.CONCLUSION:
TDR prevalence is stabilizing in high-income countries, but increasing in low/middle-income countries. This is likely due to the low, but increasing, coverage of antiretroviral therapy in these settings. Transmission of TDR is most prevalent among MSM worldwide.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
HIV
/
Farmacorresistência Viral
Tipo de estudo:
Prevalence_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article