Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Health Economics and Epidemiology Research Office, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa.
BMJ Open. 2023 Nov 19;13(11):e071283. doi: 10.1136/bmjopen-2022-071283.
OBJECTIVES: As countries have scaled up access to antiretroviral therapy (ART) for HIV, attrition rates of up to 30% annually have created a large pool of individuals who initiate treatment with prior ART experience. Little is known about the proportion of non-naïve reinitiators within the population presenting for treatment initiation. DESIGN: Systematic review of published articles and abstracts reporting proportions of non-naïve adult patients initiating ART in sub-Saharan Africa. DATA SOURCES: PubMed, Embase Elsevier, Web of Science Core Collection, International AIDS Society conferences, Conference on Retroviruses and Opportunistic Infections conferences. ELIGIBILITY CRITERIA: Clinical trials and observational studies; reporting on adults in sub-Saharan Africa who initiated lifelong ART; published in English between 1 January 2018 and 11 July 2023 and with data collected after January 2016. Initiator self-report, laboratory discernment of antiretroviral metabolites, and viral suppression at initiation or in the medical record were accepted as evidence of prior exposure. DATA EXTRACTION AND SYNTHESIS: We captured study and sample characteristics, proportions with previous ART exposure and the indicator of previous exposure reported. We report results of each eligible study, estimate the risk of bias and identify gaps in the literature. RESULTS: Of 2740 articles, 11 articles describing 12 cohorts contained sufficient information for the review. Proportions of initiators with evidence of prior ART use ranged from 5% (self-report only) to 53% (presence of ART metabolites in hair or blood sample). The vast majority of screened studies did not report naïve/non-naïve status. Metrics used to determine and report non-naïve proportions were inconsistent and difficult to interpret. CONCLUSIONS: The proportion of patients initiating HIV treatment who are truly ART naïve is not well documented. It is likely that 20%-50% of ART patients who present for ART are reinitiators. Standard reporting metrics and diligence in reporting are needed, as is research to understand the reluctance of patients to report prior ART exposure. PROSPERO REGISTRATION NUMBER: CRD42022324136.
目的：随着各国扩大艾滋病毒抗逆转录病毒疗法（ART）的可及性，每年高达 30%的患者流失率导致大量曾接受过 ART 治疗的人开始接受治疗。目前，对于开始治疗时具有先前 ART 治疗经验的人群中，非初治重新开始治疗者的比例知之甚少。
设计：对发表的文章和摘要进行系统回顾，报告撒哈拉以南非洲地区非初治成年患者开始接受抗逆转录病毒治疗的比例。
数据来源：PubMed、Embase Elsevier、Web of Science 核心合集、国际艾滋病协会会议、逆转录病毒和机会性感染会议。
入选标准：临床试验和观察性研究；报告撒哈拉以南非洲地区开始接受终身抗逆转录病毒治疗的成年人；发表于 2018 年 1 月 1 日至 2023 年 7 月 11 日期间的英文文章，数据收集时间在 2016 年 1 月之后。启动者的自我报告、实验室对抗逆转录病毒代谢物的辨别以及启动时或病历中的病毒抑制被认为是先前暴露的证据。
数据提取和综合：我们获取了研究和样本特征、有先前 ART 暴露的比例以及报告的先前暴露指标。我们报告了每项合格研究的结果，评估了偏倚风险并确定了文献中的空白。
结果：在 2740 篇文章中，有 11 篇描述了 12 个队列的文章包含了足够的信息供本综述使用。有证据表明先前使用过 ART 的启动者比例从 5%（仅自我报告）到 53%（头发或血液样本中存在 ART 代谢物）不等。绝大多数筛选的研究未报告初治/非初治状态。用于确定和报告非初治比例的指标不一致且难以解释。
结论：开始接受 HIV 治疗的患者中真正的 ART 初治者比例尚未得到充分记录。很可能有 20%-50%的开始接受 ART 治疗的患者是重新开始治疗者。需要标准的报告指标和对报告的重视，以及研究以了解患者不愿报告先前的 ART 暴露的原因。
前瞻性注册号：CRD42022324136。
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