Liu Da-jin, Feng Meng-xian, Liu Min
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Jun 18;47(3):474-82.
To estimate the prevalence of antiretroviral drug resistance in treatment-naive individuals with human immunodeficiency virus (HIV) in China.
Five electronic databases [Chinese BioMedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese Science-Technology Journal Database (VIP), Wanfang Data, and PubMed] were searched for studies of HIV drug resistance in untreated individuals. Drug resistance data were abstracted then pooled using the random effect model. Subgroup analysis was done across sampling time, location, study population (mean age and infection status), and sample size.
Seventy-six studies were included for our meta-analysis (46 in Chinese, 30 in English). The pooled rates of drug resistance to total, to non-nucleoside reverse transcriptase inhibitor (NNRTI), to nucleoside reverse transcriptase inhibitor (NRTI), and to protease inhibitor (PI) were 4.7% (95%CI:4.0%-5.4%), 2.3% (95%CI:1.8%-2.8%), 1.8% (95%CI:1.3%-2.3%), and 1.4% (95%CI: 1.1%-1.8%), respectively. All the rates before 2007 were higher than those for 2008 or later. Meanwhile, significant differences were found in the sample areas (P<0.05), in which, the rates in South-central and Southwest were both higher than 5%. The difference was complex between mean age and infection status subgroup, and we found the total prevalence in the group under 25 years and the newly infected, and confirmed group was lower than in the others. For sample size, all the rates in the group under 100 samples were higher than in the others, and the difference was significant (P<0.05).
The prevalence of HIV primary drug resistance in China was 4.7%, which stayed low, but was also close to the line set by WHO. Enhanced surveillance for drug resistance is necessary in high epidemic areas including the South-central and Southwest China whose prevalence has crossed the line.
评估中国初治的人类免疫缺陷病毒（HIV）感染者中抗逆转录病毒药物耐药性的流行情况。
检索五个电子数据库[中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）、万方数据和PubMed]，查找关于未治疗个体HIV耐药性的研究。提取耐药性数据，然后使用随机效应模型进行汇总。按抽样时间、地点、研究人群（平均年龄和感染状态）和样本量进行亚组分析。
纳入76项研究进行荟萃分析（46项中文研究，30项英文研究）。对总体、非核苷类逆转录酶抑制剂（NNRTI）、核苷类逆转录酶抑制剂（NRTI）和蛋白酶抑制剂（PI）的耐药合并率分别为4.7%（95%CI：4.0%-5.4%）、2.3%（95%CI：1.8%-2.8%）、1.8%（95%CI：1.3%-2.3%）和1.4%（95%CI：1.1%-1.8%）。2007年以前的所有耐药率均高于2008年及以后。同时，样本地区存在显著差异（P<0.05），其中，中南地区和西南地区的耐药率均高于5%。平均年龄和感染状态亚组之间的差异较为复杂，我们发现25岁以下组、新感染组和确诊组的总体流行率低于其他组。对于样本量，样本量在100例以下组的所有耐药率均高于其他组，差异有统计学意义（P<0.05）。
中国HIV原发性耐药率为4.7%，虽处于较低水平，但已接近世界卫生组织设定的界限。在包括中南地区和西南地区在内的高流行地区，鉴于其耐药率已超过界限，有必要加强耐药监测。
