Evidence map›Paper›PMID 29198909›Full record

SynthesisThe Lancet. Infectious diseases2018

HIV-1 drug resistance before initiation or re-initiation of first-line antiretroviral therapy in low-income and middle-income countries: a systematic review and meta-regression analysis.

Ravindra K Gupta, John Gregson, Neil Parkin, Hiwot Haile-Selassie, Amilcar Tanuri, Liliana Andrade Forero, Pontiano Kaleebu, Christine Watera, Avelin Aghokeng, Nicholus Mutenda and 23 more

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 245 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
245citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

245 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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185 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

33 authors.

Ravindra K GuptaDepartment of Infection, University College London, London, UK; Africa Health Research Institute, Durban, South Africa. Electronic address: ravindra.gupta@ucl.ac.uk.
John GregsonDepartment of Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Neil ParkinData First Consulting, Belmont, CA, USA.
Hiwot Haile-SelassieHIV Department, World Health Organization, Geneva, Switzerland.
Amilcar TanuriFederal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Liliana Andrade ForeroMinistry of Health, Bogotá, Columbia.
Pontiano KaleebuUganda Virus Research, Entebbe, Uganda; Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit, Entebbe, Uganda.
Christine WateraUganda Virus Research, Entebbe, Uganda; Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit, Entebbe, Uganda.
Avelin AghokengCREMER, Virology laboratory IMPM-IRD, IMPM, Yaoundé, Cameroon; IRD UMI 233, INSERM U1175, Université de Montpellier, Montpellier, France.
Nicholus MutendaMinistry of Health, Windhoek, Namibia.
Janet DzangareMinistry of Health and Child Care, Harare, Zimbabwe.
San HoneDepartment of Public Health, Ministry of Health and Sports, Yangoon, Myanmar.
Zaw Zaw HangDepartment of Public Health, Ministry of Health and Sports, Yangoon, Myanmar.
Judith GarciaDepartment of Epidemiology, Guatemala City, Guatemala.
Zully GarciaHIV Program, Ministry of Health, Guatemala City, Guatemala.
Paola MarchorroHIV Reference Laboratory, Guatemala City, Guatemala.
Enrique BetetaMinistry of Health, Managua, Nicaragua.
Amalia GironUniversidad del Valle de Guatemala Centro de Estudios en Salud, Guatemala City, Guatemala.
Raph HamersAmsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Department of Global Health, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands.
Seth InzauleAmsterdam Institute for Global Health and Development, Amsterdam, Netherlands; Department of Global Health, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands.
Lisa M FrenkelLaboratory Medicine, Global Health and Medicine, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA.
Michael H ChungDepartments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA.
Tulio de OliveiraKwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Deenan PillayDepartment of Infection, University College London, London, UK; Africa Health Research Institute, Durban, South Africa.
Kogie NaidooCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Ayesha KharsanyCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Ruthiran KugathasanDepartment of Infection, University College London Hospital, London, UK.
Teresa CutinoDepartment of Infection, University College London Hospital, London, UK.
Gillian HuntNational Institute for Communicable Diseases, Sandringham, South Africa.
Santiago Avila RiosCentre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
Meg DohertyHIV Department, World Health Organization, Geneva, Switzerland.
Michael R JordanDepartment of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, MA, USA.
Silvia BertagnolioHIV Department, World Health Organization, Geneva, Switzerland.

Funding

Medical Research Council MC_U950080938Medical Research Council MC_UU_00027/1World Health Organization 001
6 · The paper itself

Abstract

backgroundPretreatment drug resistance in people initiating or re-initiating antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTIs) might compromise HIV control in low-income and middle-income countries (LMICs). We aimed to assess the scale of this problem and whether it is associated with the intiation or re-initiation of ART in people who have had previous exposure to antiretroviral drugs.

methodsThis study was a systematic review and meta-regression analysis. We assessed regional prevalence of pretreatment drug resistance and risk of pretreatment drug resistance in people initiating ART who reported previous ART exposure. We systematically screened publications and unpublished datasets for pretreatment drug-resistance data in individuals in LMICs initiating or re-initiating first-line ART from LMICs. We searched for studies in PubMed and Embase and conference abstracts and presentations from the Conference on Retroviruses and Opportunistic Infections, the International AIDS Society Conference, and the International Drug Resistance Workshop for the period Jan 1, 2001, to Dec 31, 2016. To assess the prevalence of drug resistance within a specified region at any specific timepoint, we extracted study level data and pooled prevalence estimates within the region using an empty logistic regression model with a random effect at the study level. We used random effects meta-regression to relate sampling year to prevalence of pretreatment drug resistance within geographical regions.

findingsWe identified 358 datasets that contributed data to our analyses, representing 56 044 adults in 63 countries. Prevalence estimates of pretreatment NNRTI resistance in 2016 were 11·0% (7·5-15·9) in southern Africa, 10·1% (5·1-19·4) in eastern Africa, 7·2% (2·9-16·5) in western and central Africa, and 9·4% (6·6-13·2) in Latin America and the Caribbean. There were substantial increases in pretreatment NNRTI resistance per year in all regions. The yearly increases in the odds of pretreatment drug resistance were 23% (95% CI 16-29) in southern Africa, 17% (5-30) in eastern Africa, 17% (6-29) in western and central Africa, 11% (5-18) in Latin America and the Caribbean, and 11% (2-20) in Asia. Estimated increases in the absolute prevalence of pretreatment drug resistance between 2015 and 2016 ranged from 0·3% in Asia to 1·8% in southern Africa.

interpretationPretreatment drug resistance is increasing at substantial rate in LMICs, especially in sub-Saharan Africa. In 2016, the prevalence of pretreatment NNRTI resistance was near WHO's 10% threshold for changing first-line ART in southern and eastern Africa and Latin America, underscoring the need for routine national HIV drug-resistance surveillance and review of national policies for first-line ART regimen composition.

fundingBill & Melinda Gates Foundation and World Health Organization.

Indexed as

Developing CountriesAnti-HIV AgentsHIV-1HIV InfectionsHumansAnti-HIV Agents

Identifiers

PMID29198909
PMCPMC5835664

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.