PDF(Pubmed)
Abstract：
Despite the widespread use of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) transmission, scant information on HIV drug resistance mutations (DRMs) has been gathered over the past decade. This review aimed to estimate the pooled prevalence of pre-exposure prophylaxis and its two-way impact on DRM.
We systematically reviewed studies on DRM in pre-exposure prophylaxis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. PubMed, Cochrane, and SAGE databases were searched for English-language primary studies published between January 2001 and December 2023. The initial search was conducted on 9 August 2021 and was updated through 31 December 2023 to ensure the inclusion of the most recent findings. The registration number for this protocol review was CRD42022356061.
A total of 26,367 participants and 562 seroconversion cases across 12 studies were included in this review. The pooled prevalence estimate for all mutations was 6.47% (95% Confidence Interval-CI 3.65-9.93), while Tenofovir Disoproxil Fumarate/Emtricitabine-associated drug resistance mutation prevalence was 1.52% (95% CI 0.23-3.60) in the pre-exposure prophylaxis arm after enrolment. A subgroup analysis, based on the study population, showed the prevalence in the heterosexual and men who have sex with men (MSM) groups was 5.53% (95% CI 2.55-9.40) and 7.47% (95% CI 3.80-12.11), respectively. Notably, there was no significant difference in the incidence of DRM between the pre-exposure prophylaxis and placebo groups (log-OR = 0.99, 95% CI -0.20 to 2.18, I2 = 0%; p = 0.10).
Given the constrained prevalence of DRM, the World Health Organization (WHO) advocates the extensive adoption of pre-exposure prophylaxis. Our study demonstrated no increased risk of DRM with pre-exposure prophylaxis (p > 0.05), which is consistent with these settings. These findings align with the previous meta-analysis, which reported a 3.14-fold higher risk in the pre-exposure prophylaxis group than the placebo group, although the observed difference did not reach statistical significance (p = 0.21).
Despite the low prevalence of DRM, pre-exposure prophylaxis did not significantly increase the risk of DRM compared to placebo. However, long-term observation is required to determine further disadvantages of extensive pre-exposure prophylaxis use. PROSPERO Number: CRD42022356061.
We systematically reviewed studies on DRM in pre-exposure prophylaxis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. PubMed, Cochrane, and SAGE databases were searched for English-language primary studies published between January 2001 and December 2023. The initial search was conducted on 9 August 2021 and was updated through 31 December 2023 to ensure the inclusion of the most recent findings. The registration number for this protocol review was CRD42022356061.
A total of 26,367 participants and 562 seroconversion cases across 12 studies were included in this review. The pooled prevalence estimate for all mutations was 6.47% (95% Confidence Interval-CI 3.65-9.93), while Tenofovir Disoproxil Fumarate/Emtricitabine-associated drug resistance mutation prevalence was 1.52% (95% CI 0.23-3.60) in the pre-exposure prophylaxis arm after enrolment. A subgroup analysis, based on the study population, showed the prevalence in the heterosexual and men who have sex with men (MSM) groups was 5.53% (95% CI 2.55-9.40) and 7.47% (95% CI 3.80-12.11), respectively. Notably, there was no significant difference in the incidence of DRM between the pre-exposure prophylaxis and placebo groups (log-OR = 0.99, 95% CI -0.20 to 2.18, I2 = 0%; p = 0.10).
Given the constrained prevalence of DRM, the World Health Organization (WHO) advocates the extensive adoption of pre-exposure prophylaxis. Our study demonstrated no increased risk of DRM with pre-exposure prophylaxis (p > 0.05), which is consistent with these settings. These findings align with the previous meta-analysis, which reported a 3.14-fold higher risk in the pre-exposure prophylaxis group than the placebo group, although the observed difference did not reach statistical significance (p = 0.21).
Despite the low prevalence of DRM, pre-exposure prophylaxis did not significantly increase the risk of DRM compared to placebo. However, long-term observation is required to determine further disadvantages of extensive pre-exposure prophylaxis use. PROSPERO Number: CRD42022356061.
摘要：
背景：尽管在预防人类免疫缺陷病毒（HIV）传播中广泛使用暴露前预防（PrEP），在过去的十年中，有关HIV耐药性突变（DRMs）的信息很少。这篇综述旨在估计暴露前预防的汇总患病率及其对DRM的双向影响。
方法：我们根据2020年系统评价和荟萃分析指南的首选报告项目，系统地回顾了DRM在暴露前预防中的研究。PubMed,科克伦,我们在SAGE数据库中搜索了2001年1月至2023年12月期间发表的英语主要研究.初步搜索于2021年8月9日进行，并在2023年12月31日之前进行了更新，以确保包含最新的调查结果。该方案审查的注册号为CRD42022356061。
结果：在12项研究中，共有26,367名参与者和562例血清转换病例被纳入本综述。所有突变的合并患病率估计值为6.47%（95%置信区间-CI3.65-9.93），而富马酸替诺福韦酯/恩曲他滨相关耐药突变患病率在纳入后的暴露前预防组中为1.52%(95%CI0.23-3.60).亚组分析，根据研究人群，显示异性恋和男男性行为者（MSM）组中的患病率为5.53％（95％CI2.55-9.40）和7.47％（95％CI3.80-12.11），分别。值得注意的是,暴露前预防组和安慰剂组的DRM发生率无显著差异(log-OR=0.99,95%CI-0.20~2.18,I2=0%;p=0.10).
结论：鉴于DRM的受限流行，世界卫生组织（WHO）提倡广泛采用暴露前预防。我们的研究表明，暴露前预防不会增加DRM的风险(p>0.05)，这与这些设置是一致的。这些发现与之前的荟萃分析一致，据报道，暴露前预防组的风险比安慰剂组高3.14倍，尽管观察到的差异没有达到统计学意义（p=0.21）。
结论：尽管DRM的患病率较低，与安慰剂相比,暴露前预防并未显著增加DRM的风险.然而,需要长期观察以确定广泛的暴露前预防使用的其他缺点.PROSPERO编号：CRD42022356061。
方法：我们根据2020年系统评价和荟萃分析指南的首选报告项目，系统地回顾了DRM在暴露前预防中的研究。PubMed,科克伦,我们在SAGE数据库中搜索了2001年1月至2023年12月期间发表的英语主要研究.初步搜索于2021年8月9日进行，并在2023年12月31日之前进行了更新，以确保包含最新的调查结果。该方案审查的注册号为CRD42022356061。
结果：在12项研究中，共有26,367名参与者和562例血清转换病例被纳入本综述。所有突变的合并患病率估计值为6.47%（95%置信区间-CI3.65-9.93），而富马酸替诺福韦酯/恩曲他滨相关耐药突变患病率在纳入后的暴露前预防组中为1.52%(95%CI0.23-3.60).亚组分析，根据研究人群，显示异性恋和男男性行为者（MSM）组中的患病率为5.53％（95％CI2.55-9.40）和7.47％（95％CI3.80-12.11），分别。值得注意的是,暴露前预防组和安慰剂组的DRM发生率无显著差异(log-OR=0.99,95%CI-0.20~2.18,I2=0%;p=0.10).
结论：鉴于DRM的受限流行，世界卫生组织（WHO）提倡广泛采用暴露前预防。我们的研究表明，暴露前预防不会增加DRM的风险(p>0.05)，这与这些设置是一致的。这些发现与之前的荟萃分析一致，据报道，暴露前预防组的风险比安慰剂组高3.14倍，尽管观察到的差异没有达到统计学意义（p=0.21）。
结论：尽管DRM的患病率较低，与安慰剂相比,暴露前预防并未显著增加DRM的风险.然而,需要长期观察以确定广泛的暴露前预防使用的其他缺点.PROSPERO编号：CRD42022356061。
