Abstract
BackgroundSurveillance of drug resistance in antiretroviral treatment-naïve patients in China is needed to ensure optimal treatment outcomes and control of the human immunodeficiency virus (HIV) epidemic.MethodsA systematic literature search was conducted in English and Chinese through PubMed (English), China National Knowledge Infrastructure (Chinese), Chinese Biomedical Literature Database (Chinese), and Wanfang (Chinese). Random effects models were used to calculate the pooled prevalence of transmitted drug resistance and subgroup analyses examined prevalence estimates across time periods, study locations, and study populations.ResultsAnalysis of data from 71 studies (47 in Chinese and 24 in English) yielded a pooled prevalence of transmitted HIV drug resistance to any antiretroviral drug class of 3.64% (95% confidence interval [CI]: 3.00%–4.32%). Rates were significantly high at initial stage of free ART program from 2003 to 2005 (5.18%, 95%CI: 3.13%–7.63%), and were much lower among studies conducted in 2006–2008 (3.02%, 95%CI: 2.03%–4.16%). A slight increase was observed again in the most recent study period from 2009 to 2012 (3.68%, 95%CI: 2.78%–4.69%). Subgroup analysis revealed highest prevalence levels of transmitted drug resistance in Beijing city, and Henan and Hubei provinces (above 5%), and although differences in prevalence rates among risk groups were negligible, men who have sex with men were unique in their relatively large portion of protease inhibitor resistance, a second-line drug of limited availability in China.ConclusionsOverall prevalence of transmitted HIV drug resistance in China is classified as “low” by the World Health Organization. However regional and temporal variability suggest a more complex epidemic for which closer HIV drug resistance surveillance is needed. A nationwide HIV drug resistance surveillance system to monitor both treatment-experienced and treatment-naïve patients will be a cornerstone to ensure the effectiveness of treatment scale-up, particularly as China seeks to expand a national policy of antiretroviral treatment as prevention.
Highlights
China has one of the largest populations of persons infected with human immunodeficiency virus type-1(HIV-1)
As of 2007, data from the national case report system has suggested that heterosexual transmission (HST) has become the primary mode of transmission in China, signaling a potential transmission to a more generalized epidemic [1].Of the about 70,000 new HIV diagnoses from January to September in 2013, those believe to be acquired through unprotected sex accounted for 89.9% [3]
Study selection and characteristics Of the 4964 articles (4656 in China National Knowledge Infrastructure (Chinese), 308 in English) initially identified, of which 1934 were excluded as duplicates, another 2858 were removed for relevance based on a title and abstract screening
Summary
China has one of the largest populations of persons infected with human immunodeficiency virus type-1(HIV-1). To combat the spread of HIV through the general population, the Chinese Center for Disease Control has launched a policy initiative to harness suppressive antiretroviral therapy (ART) to slow the spread of HIV in China. By the end of September 2013, the national free ART program has treated about 260,000 cumulative patients [3], and has reduced AIDS associated mortality from 39.3 to 14.2 deaths per 100 persons from 2002 to 2009 [6]. Surveillance of drug resistance in antiretroviral treatment-naıve patients in China is needed to ensure optimal treatment outcomes and control of the human immunodeficiency virus (HIV) epidemic
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