Balew Melashu, Abeje Gedefaw, Mekonnen Alemtsehay, Degu Getu
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Health Research Development Directorate, Amhara Public Health Institute, Bahir Dar, Ethiopia.
BMC Public Health. 2025 Jun 3;25(1):2059. doi: 10.1186/s12889-025-23193-2.
The emergence of human immunodefiency virus (HIV) drug resistance presents a substantial challenge. Alternatives for effective treatment regimens are limited, and treatment strategies are complicated. Although a number of primary studies have been performed on HIV drug resistance in Ethiopia, individual study often lacks the statistical strength to draw conclusion. Therefore, the objective of this systematic review and meta-analysis was to estimate the pooled prevalence of HIV1 drug resistance among patients experiencing first-line treatment failure in Ethiopia.
Primary studies were searched from PubMed, SCOPUS, Embase, Google Scholar and online libraries. Studies identified through the search strategies were screened by titles and abstracts. Included studies were evaluated for risk of bias using the Joanna Briggs Institute (JBI) checklist. Data were extracted, and the pooled prevalence of HIV drug resistance was computed using STATA 17 software. Subgroup analysis and meta-regression were performed to identify heterogeneity. Publication bias was checked visually and statistically. Narrative synthesis was performed to describe study characteristics and findings; and forest plots were used to visually represent effect sizes and confidence intervals from individual studies to present and synthesize the results.
A total of 10 studies with 1233 participants were included. The pooled prevalence rate of HIV drug resistance in patients with first line treatment failure was 73% (95% CI: 67-78%, I = 68.1%, P < 0.001). It was increased over time: 67.2% from 2008 to 2015 (I = 47.8%, P = 0.088) and 77.7% from 2016 to 2020 (I = 60.4%, P = 0.056). The prevalence rate was 82.6% (I = 0.0%; P = 0.532) in Southern Nations Nationalities People, 70.15% (I = 41.5%, P = 0.19) in Oromia, and 53% (I = 50.7%, P = 0.54) in Amhara regions.
The prevalence rate of HIV drug resistance in Ethiopia is high. This alarms health care workers, programmers and decision makers to consider ways of controlling the emergence of HIV drug resistance and the spread of drug-resistant strains. Timely monitoring of treatment failures, HIV drug resistance testing and switching on appropriate regimen classes are crucial for better treatment outcomes. There was high HIV drug resistance among children but with a high heterogeneity indicating the need for more primary studies.
PROSPERO CRD42024533975.
人类免疫缺陷病毒（HIV）耐药性的出现带来了巨大挑战。有效治疗方案的选择有限，治疗策略也很复杂。尽管埃塞俄比亚已经开展了多项关于HIV耐药性的初步研究，但个别研究往往缺乏得出结论的统计力度。因此，本系统评价和荟萃分析的目的是估计埃塞俄比亚一线治疗失败患者中HIV-1耐药性的合并患病率。
从PubMed、SCOPUS、Embase、谷歌学术和在线图书馆检索初步研究。通过检索策略确定的研究通过标题和摘要进行筛选。使用乔安娜·布里格斯研究所（JBI）检查表对纳入研究的偏倚风险进行评估。提取数据，并使用STATA 17软件计算HIV耐药性的合并患病率。进行亚组分析和元回归以识别异质性。通过直观检查和统计分析来检验发表偏倚。进行叙述性综合以描述研究特征和结果；森林图用于直观呈现个体研究的效应大小和置信区间，以展示和综合结果。
共纳入10项研究，1233名参与者。一线治疗失败患者中HIV耐药性的合并患病率为73%（95%CI：67-78%，I²=68.1%，P<0.001）。随着时间推移有所增加：2008年至2015年为67.2%（I²=47.8%，P=0.088），2016年至2020年为77.7%（I²=60.4%，P=0.056）。在南方各族人民地区患病率为82.6%（I²=0.0%；P=0.532），在奥罗米亚为70.15%（I²=41.5%，P=0.19），在阿姆哈拉地区为53%（I²=50.7%，P=0.54）。
埃塞俄比亚HIV耐药性患病率很高。这警示医护人员、规划者和决策者要考虑控制HIV耐药性出现和耐药菌株传播的方法。及时监测治疗失败情况、进行HIV耐药性检测并切换到合适的治疗方案类别对于取得更好的治疗效果至关重要。儿童中HIV耐药性较高，但异质性也高，这表明需要更多的初步研究。
PROSPERO CRD42024533975
