Bertagnolio_Clinical impact of PDR.pdf (598.93 kB)
Clinical impact of pretreatment human immunodeficiency virus drug resistance in people initiating nonnucleoside reverse transcriptase inhibitor-containing antiretroviral therapy: a systematic review and meta-analysis
journal contribution
posted on 2023-06-10, 03:52 authored by Silvia Bertagnolio, Lucas Hermans, Michael R Jordan, Santiago Avila-Rios, Collins IwujiCollins Iwuji, Anne Derache, Eric Delaporte, Annemarie Wensing, Theresa Aves, A S M Borhan, Alvin Leenus, Neil Parkin, Meg Doherty, Seth Inzaule, Lawrence MbuagbawBackground: Increased access to antiretroviral therapy (ART) has resulted in rising levels of pretreatment human immunodeficiency virus drug resistance (PDR). This is the first systematic review and meta-analysis to assess the impact of PDR on treatment outcomes among people initiating nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART, including the combination of efavirenz (EFV), tenofovir (TDF), and lamivudine or emtricitabine (XTC). Methods: We systematically reviewed studies and conference proceedings comparing treatment outcomes in populations initiating NNRTI-based ART with and without PDR. We conducted subgroup analyses by regimen: (1) NNRTIs + 2 nucleoside reverse transcriptase inhibitors (NRTIs), (2) EFV + 2 NRTIs, or (3) EFV/TDF/XTC; by population (children vs adults); and by definition of resistance (PDR vs NNRTI PDR). Results: Among 6197 studies screened, 32 were analyzed (31 441 patients). We found that individuals with PDR initiating NNRTIs across all the subgroups had increased risk of virological failure compared to those without PDR. Risk of acquisition of new resistance mutations and ART switch was also higher in people with PDR. Conclusions: This review shows poorer treatment outcomes in the presence of PDR, supporting the World Health Organization's recommendation to avoid using NNRTIs in countries where levels of PDR are high.
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Publication status
- Published
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- Published version
Journal
Journal of Infectious DiseasesISSN
0022-1899Publisher
Oxford University Press (OUP)External DOI
Issue
3Volume
224Page range
377-388Event location
United StatesDepartment affiliated with
- Global Health and Infection Publications
Full text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2022-06-14First Open Access (FOA) Date
2022-06-14First Compliant Deposit (FCD) Date
2022-06-13Usage metrics
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