Systematic Review of HIV Drug Resistance in the World Health Organization Southeast Asia Region

摘要

In 2010, 3.5 million people were living with HIV in the World Health Organization (WHO) Southeast Asia Region (SEAR), giving this region the greatest burden of HIV after Africa. Scale-up of antiretroviral therapy (ART) has resulted in over 717,000 benefitting from it at the end of 2010. A systematic review of studies of HIV drug resistance (HIVDR) in SEAR published between 2000 and 2011 was performed. Of 10 studies of transmitted HIVDR in recently infected patients, all but two reported low levels (<5%) of transmitted HIVDR. Of 23 studies of HIVDR in pre-treatment populations initiating ART, three reported moderate levels (5–15%) of HIVDR and 20 reported low levels. Amongst 17 studies of acquired HIVDR, levels of nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance ranged from 52%–92% and 43%–100%, respectively amongst those with virological failure. Overall, data included in this review suggest that currently recommended first- and second-line regimens are appropriate for the cohorts studied. However, data were only available from two of 11 SEAR countries and studies largely examined urban populations. Results are unlikely to be representative of the region. Studies lacked standardized methods which greatly limit comparability of data and their use for public health and ART program planning. Routine, standardized and nationally representative HIVDR surveillance should be strongly encouraged in SEAR to best characterize population-level HIVDR. National-level HIVDR surveillance data may be used to optimize delivery of HIV care and treatment and minimize emergence of population-level HIVDR, thus promoting the long-term efficacy and durability of available first- and second-line ART regimens.