东非接受抗逆转录病毒治疗的艾滋病毒感染者中病毒学失败的患病率及预测因素：来自对2016年至2023年已发表研究的系统评价、荟萃分析和荟萃回归的证据
Prevalence and predictors of virological failure among the people living with HIV on antiretroviral treatment in East Africa: evidence from a systematic review with meta-analysis and meta-regression of published studies from 2016 to 2023.
作者信息
Namaganda Maria Magdalene, Mukasa Kafeero Hussein, Nakatumba Nabende Joyce, Kateete David Patrick, Batte Charles, Wanyengera Misaki, Jjingo Daudi, Joloba Moses, Kivunike Florence, Ssewanyana Isaac, Miya Yunus, Kato Darius, Ouma Simple, Kakembo Frederick Elishama, Kanyerezi Stephen, Kabahiita Jupiter Marina, Muwanda Fahad, Mboowa Gerald
机构信息
Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
The African Center of Excellence in Bioinformatics and Data-Intensive Science (ACE), Kampala, Uganda.
出版信息
HIV Res Clin Pract. 2025 Dec;26(1):2490774. doi: 10.1080/25787489.2025.2490774. Epub 2025 Apr 11.
BACKGROUND
Virological failure (VF) significantly threatens the efficacy of antiretroviral therapy (ART) programs in East Africa. This systematic review and meta-analysis assess the prevalence and predictors of VF among individuals living with HIV.
METHODS
We searched PubMed, Web of Science, African Journals Online, and EMBASE for relevant studies. Heterogeneity was assessed using the statistic, and random-effects models addressed between-study variability. Publication bias was examined through funnel plots, Egger's regression, and Begg's tests. Subgroup analyses and meta-regression explored heterogeneity sources and potential VF predictors. Analyses were conducted using MedCalc version 20.010, adhering to PRISMA 2020 guidelines.
RESULTS
Twenty-five records were included, with a sample size of 29,829 people living with HIV on ART. The pooled prevalence of VF in East Africa was 19.4% (95% CI: 15.2%-24.0%), with substantial heterogeneity across studies. Sociodemographic predictors of VF included male sex (30.9%, < .001), unmarried status (28.2%, < .001), lower educational attainment (33.0%, < .001), non-formal employment (47.2%, < .001), and urban residence (51.2%, < .001). Clinical factors associated with higher VF rates were ambulatory status (44.7%, < .001), low CD4 count (35.1%, < .001), low haemoglobin (52.2%, < .001), advanced HIV stage III/IV (44.2%, < .001), HIV/TB co-infection (24.3%, < .001), and other opportunistic infections (20.5%, = .008). Treatment-related factors associated with VF were first-line nevirapine-based regimen (27.7%, = .009) and poor ART adherence (41.76%, < .001).
CONCLUSION
Sociodemographic factors, advanced HIV disease, co-morbidities, poor adherence, and specific first-line ART regimens are key predictors of virological failure. Targeted, multidisciplinary interventions focusing on routine viral load monitoring, adherence support, and addressing socioeconomic barriers are essential to improve ART outcomes in East Africa.
背景
病毒学失败（VF）严重威胁着东非抗逆转录病毒治疗（ART）项目的疗效。本系统评价和荟萃分析评估了HIV感染者中病毒学失败的患病率及其预测因素。
方法
我们在PubMed、科学网、非洲期刊在线和EMBASE中检索相关研究。使用统计量评估异质性，并采用随机效应模型处理研究间的变异性。通过漏斗图、Egger回归和Begg检验来检测发表偏倚。亚组分析和荟萃回归探索了异质性来源和潜在的病毒学失败预测因素。使用MedCalc 20.010版本进行分析，遵循PRISMA 2020指南。
结果
纳入了25篇记录，样本量为29829名接受抗逆转录病毒治疗的HIV感染者。东非病毒学失败的合并患病率为19.4%（95%置信区间：15.2%-24.0%），各研究间存在显著异质性。病毒学失败的社会人口学预测因素包括男性（30.9%，P<0.001）、未婚状态（28.2%，P<0.001）、较低的教育程度（33.0%，P<0.001）、非正规就业（47.2%，P<0.001）和城市居住（51.2%，P<0.001）。与较高病毒学失败率相关的临床因素包括门诊状态（44.7%，P<0.001）、低CD4细胞计数（35.1%，P<0.001）、低血红蛋白（52.2%，P<0.001）、晚期HIV III/IV期（44.2%，P<0.001）、HIV/TB合并感染（24.3%，P<0.001）和其他机会性感染（20.5%，P=0.008）。与病毒学失败相关的治疗相关因素包括基于奈韦拉平的一线治疗方案（27.7%，P=0.009）和抗逆转录病毒治疗依从性差（41.76%，P<0.001）。
结论
社会人口学因素、晚期HIV疾病、合并症、依从性差以及特定的一线抗逆转录病毒治疗方案是病毒学失败的关键预测因素。针对常规病毒载量监测、依从性支持以及解决社会经济障碍的有针对性的多学科干预对于改善东非抗逆转录病毒治疗结果至关重要。
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