撒哈拉以南非洲主要人群暴露前预防失败后的艾滋病毒耐药性：一项系统评价和荟萃分析方案

HIV drug resistance following pre-exposure prophylaxis failure among key populations in sub-Saharan Africa: a systematic review and meta-analysis protocol.

作者信息

Ngoufack Jagni Semengue Ezechiel, Molimbou Evariste, Etame Naomi-Karell, Ka'e Christelle Aude, Ambe Collins Chenwi, Nka Alex Durand, Tueguem Pamela Patricia, Ngueko Aurelie Minelle Kengni, Mundo Rachel Audrey Nayang, Takou Désiré, Anoubissi Jean-De-Dieu, Akiy Zacheaus Zeh, Kob Ye Same David Anouar, Ngougo Duplextine Aimée, Billong Serges, Perno Carlo-Federico, Ndembi Nicaise, Fokam Joseph

机构信息

Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon.

National HIV Drug Resistance Working Group, Ministry of Public Health, Yaoundé, Cameroon.

出版信息

Ther Adv Infect Dis. 2024 Dec 14;11:20499361241306207. doi: 10.1177/20499361241306207. eCollection 2024 Jan-Dec.

DOI:10.1177/20499361241306207

PMID:39678994

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11645767/

Abstract

BACKGROUND

Key populations (KP) are highly vulnerable to HIV acquisition and account for 70% of new infections worldwide. To optimize HIV prevention among KP, the World Health Organization recommends the combination of emtricitabine plus tenofovir disoproxil fumarate for pre-exposure prophylaxis (PrEP). However, PrEP failure could be attributed to drug resistance mutations (DRMs) but this is unexplored in sub-Saharan Africa (SSA).

OBJECTIVES

We aim to conduct a systematic review that will provide evidence on the prevalence of HIV drug resistance (HIVDR) following PrEP failure among KP in SSA.

DESIGN

This will be a systematic review and meta-analysis of studies conducted in sub-Saharan Africa.

METHODS AND ANALYSIS

This systematic review will include randomized and non-randomized trials, cohorts, case controls, cross-sectional studies, and case reports evaluating the prevalence of HIVDR following PrEP failure among KP (i.e., gay men and men who have sex with men, female sex workers, transgenders, people who inject drugs, prisoners, and detainees) in SSA. Results will be stratified according to various KP, age groups (adolescents and adults), and geographic locations. Primary outcomes will be "the prevalence of PrEP failure among KP" and "the prevalence of HIVDR after PrEP failure" in SSA. Secondary outcomes would be "the prevalence of DRMs and drug susceptibility" and "the level of adherence to PrEP." A random-effects model will be used to calculate pooled prevalence if data permit and we will explore potential sources of heterogeneity.

DISCUSSION

Our findings will provide estimates of HIVDR following PrEP failure among KP in SSA. In addition, determinants of PrEP failure and driving factors of the emergence of DRMs will also be investigated. Evidence will help in selecting effective antiretrovirals for use in PrEP among KP in SSA.

REGISTRATION

PROSPERO: CRD42023463862.

摘要

背景

重点人群极易感染艾滋病毒，占全球新增感染病例的70%。为了优化重点人群中的艾滋病毒预防工作，世界卫生组织建议使用恩曲他滨加替诺福韦酯进行暴露前预防（PrEP）。然而，PrEP失败可能归因于耐药突变（DRMs），但在撒哈拉以南非洲（SSA）尚未对此进行研究。

目的

我们旨在进行一项系统评价，以提供关于SSA重点人群中PrEP失败后艾滋病毒耐药性（HIVDR）流行情况的证据。

设计

这将是一项对撒哈拉以南非洲开展的研究进行的系统评价和荟萃分析。

方法与分析

这项系统评价将纳入随机和非随机试验、队列研究、病例对照研究、横断面研究以及病例报告，评估SSA重点人群（即男同性恋者和与男性发生性关系的男性、女性性工作者、 transgender、注射吸毒者、囚犯和被拘留者）中PrEP失败后HIVDR的流行情况。结果将根据不同的重点人群、年龄组（青少年和成年人）以及地理位置进行分层。主要结局将是SSA中“重点人群中PrEP失败的流行率”和“PrEP失败后HIVDR的流行率”。次要结局将是“DRMs和药物敏感性的流行率”以及“PrEP的依从水平”。如果数据允许，将使用随机效应模型计算合并流行率，我们还将探索潜在的异质性来源。