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2016;11 (6): e0158560.

Surveillance of HIV Transmitted Drug Resistance in Latin America and the Caribbean: A Systematic Review and Meta-Analysis.

Santiago Avila-Rios, Omar Sued, Soo-Yon Rhee, Robert W Shafer, Gustavo Reyes-Teran, Giovanni Ravasi
Author Information
  1. Santiago Avila-Rios: Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
  2. Omar Sued: Clinical Research Section, Huésped Foundation, Buenos Aires, Argentina.
  3. Soo-Yon Rhee: Department of Medicine, Stanford University, Stanford, California, United States of America.
  4. Robert W Shafer: Department of Medicine, Stanford University, Stanford, California, United States of America.
  5. Gustavo Reyes-Teran: Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
  6. Giovanni Ravasi: Pan American Health Organization (PAHO), Washington DC, United States of America.
PMID: 27355626 DOI: 10.1371/journal.pone.0158560

Abstract

BACKGROUND: HIV transmitted drug resistance (TDR) remains at moderate level in Latin America and the Caribbean (LAC). However, different epidemiologic scenarios could influence national and sub-regional TDR levels and trends.
METHODS AND FINDINGS: We performed a systematic review of currently available publications on TDR in antiretroviral treatment-naïve adults in LAC. Ninety-eight studies published between January 2000 and June 2015 were included according to critical appraisal criteria and classified by sub-region: Brazil (50), Mesoamerica (17), Southern Cone (16), Andean (8) and Caribbean (7). From these, 81 studies encompassing 11,441 individuals with data on DR mutation frequency were included in a meta-analysis. Overall TDR prevalence in LAC was 7.7% (95% CI: 7.2%-8.2%). An increasing trend was observed for overall TDR when comparing 2000-2005 (6.0%) and 2006-2015 (8.2%) (p<0.0001), which was associated with significant NNRTI TDR increase (p<0.0001). NRTI TDR decreased (4.5% vs. 2.3%, p<0.0001). NNRTI TDR increase was associated mainly with K101E, K103N and G190A. NRTI TDR decrease was associated mainly with M184V, K70R and T215Y. All sub-regions reached moderate overall TDR levels. The rapid increase in TDR to all antiretroviral classes in the Caribbean is notable, as well as the significant increase in NNRTI TDR reaching moderate levels in the Southern Cone. NRTI TDR was dominant in 2000-2005, mainly in the Caribbean, Mesoamerica and Brazil. This dominance was lost in 2006-2015 in all sub-regions, with the Southern Cone and the Caribbean switching to NNRTI dominance. PI TDR remained mostly constant with a significant increase only observed in the Caribbean.
CONCLUSIONS: Given the high conceptual and methodological heterogeneity of HIV TDR studies, implementation of surveys with standardized methodology and national representativeness is warranted to generate reliable to inform public health policies. The observed increasing trend in NNRTI TDR supports the need to strengthen TDR surveillance and programme monitoring and evaluation in LAC.

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Grants

  1. R01 AI068581/NIAID NIH HHS

MeSH Term

Adult
Anti-HIV Agents
Brazil
Caribbean Region
Drug Resistance, Viral
Epidemiological Monitoring
Female
HIV Infections
HIV-1
Humans
Latin America
Male
Mutation
Pregnancy
Pregnancy Complications, Infectious
Prevalence

Chemicals

Anti-HIV Agents
Journal Article Meta-Analysis Review Systematic Review
Article has an altmetric score of 4

Word Cloud

Created with Highcharts 10.0.0TDRCaribbeanNNRTIincreaseLACHIVmoderatelevelsstudiesSouthernCone7observedp<00001associatedsignificantNRTImainlyLatinAmericanationalantiretroviralincludedBrazilMesoamerica82%increasingtrendoverall2000-20052006-2015sub-regionsdominanceBACKGROUND:transmitteddrugresistanceremainslevelHoweverdifferentepidemiologicscenariosinfluencesub-regionaltrendsMETHODSANDFINDINGS:performedsystematicreviewcurrentlyavailablepublicationstreatment-naïveadultsNinety-eightpublishedJanuary2000June2015accordingcriticalappraisalcriteriaclassifiedsub-region:501716Andean81encompassing11441individualsdataDRmutationfrequencymeta-analysisOverallprevalence7%95%CI:2%-8comparing60%decreased45%vs23%K101EK103NG190AdecreaseM184VK70RT215YreachedrapidclassesnotablewellreachingdominantlostswitchingPIremainedmostlyconstantCONCLUSIONS:GivenhighconceptualmethodologicalheterogeneityimplementationsurveysstandardizedmethodologyrepresentativenesswarrantedgeneratereliableinformpublichealthpoliciessupportsneedstrengthensurveillanceprogrammemonitoringevaluationSurveillanceTransmittedDrugResistanceCaribbean:SystematicReviewMeta-Analysis

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