Among HIV patients in China, an increasing trend of drug resistance has been associated with long-term ART, according to recent findings.
“[ART] has led to a dramatic decrease in AIDS-related morbidity and mortality through sustained suppression of HIV replication and reconstitution of the immune response,” researchers wrote in Clinical Infectious Diseases. “However, the eventual development of HIV drug resistance over time is largely inevitable at the population level, and is one of the strongest predictors of treatment failure.”
In a systematic review and meta-analysis, the researchers conducted a literature search of various databases, seeking studies pertaining to HIV drug resistance in China. They identified 25 studies eligible for inclusion in the analysis, including 12 cohort studies (n=2,908) and 13 cross-sectional studies (n=6,553). Pooled estimates were calculated for prevalence of HIV drug resistance at key time points after commencement of ART.
The calculations were done separately for cohort studies and cross-sectional studies. Subgroup analyses were conducted for the cohort studies based on type of ART(regimens including or not including didanosine), route of HIV transmission and type of primary health care facility (ie, village clinic or public hospital) where treatment was administered.
The researchers found that in the longitudinal cohort studies, the pooled prevalence of HIV drug resistance was 10.79% (95% CI, 5.85%-19.07%) after 12 months of ART, and 80.58% (95% CI, 76.6%-84.02%) after 72 months of ART. In the cross-sectional studies, the results were presented through time intervals; at 0 to 12 months post-ART treatment, the pooled prevalence of HIV drug resistance was 11.1% (95% CI, 7.49%-16.14%). At 61 to 72 months post-ART treatment, this rate increased to 22.92% (95% CI, 9.45%-45.86%). The subgroup analysis revealed that patients administered a didanosine-based regimen had a higher prevalence of HIV drug resistance vs. those on a non-didanosine regimen (15.82% vs. 4.97%)
There was a higher pooled prevalence of HIV drug resistance among patients who acquired HIV through previous plasma donation vs. those infected through sexual transmission, and a higher prevalence among those treated at village clinics vs. public hospitals.
Although the researchers acknowledged that this trend is cause for concern, they noted that other parts of the world with longer HIV treatment histories have also experienced increases in the prevalence of HIV drug resistance.
“Although the overall pooled rates of HIV [drug resistance] in this analysis are by no means low, China’s HIV [drug resistance] problem does not appear to be more serious than other developing country settings,” the researchers wrote. “As China continues to build healthcare infrastructure, routine virologic monitoring and adherence support will be critical for controlling the emergence of drug resistance.”
Disclosure: The researchers report no relevant disclosures.