儿童HIV-1耐药性及其对儿科治疗策略的影响：一项系统评价和荟萃分析。

HIV-1 Drug Resistance in Children and Implications for Pediatric Treatment Strategies: A Systematic Review and Meta-analysis.

作者信息

Fokam Joseph, Ka'e Aude Christelle, Yagai Bouba, Santoro Maria Mercedes, Otieno Judith Kose, Rakhmanina Natella, Chenwi Collins Ambe, Nka Alex Durand, Ngoufack Jagni Semengue Ezechiel, Gouissi Davy-Hyacinthe, Togna Willy Leroi Pabo, Kamgaing Nelly, Suzie Tetang, Takou Desire, Teto Georges, Tekoh Tatiana, Gabisa Jeremiah Efakika, Nayang Mundo Audrey, Forgwei Lum, Etame Naomi-Karell, Kengni Ngueko Aurelie Minelle, Tommo Tchouaket Michel Carlos, Tchounga Boris, Tchendjou Patrice, Bouba Pamen Joelle Nounouce, Ajeh Awoh Rogers, Halle-Ekane Gregory-Edie, Cappelli Giulia, Ndjolo Alexis, Ceccherini-Silberstein Francesca, Colizzi Vittorio, Kaseya Jean, Ndembi Nicaise, Perno Carlo Federico

机构信息

Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.

Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon.

出版信息

Open Forum Infect Dis. 2025 Jun 26;12(7):ofaf378. doi: 10.1093/ofid/ofaf378. eCollection 2025 Jul.

DOI:10.1093/ofid/ofaf378

PMID:40698034

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12282363/

Abstract

INTRODUCTION

Failure in the prevention of mother-to-child HIV transmission (PMTCT) and pediatric treatment challenges led to pretreatment drug resistance (PDR) and acquired drug resistance (ADR) in children with HIV (CWHIV).

METHOD

Interventional and observational data published between 2010 and 2024 on PDR and ADR in CWHIV were included and analyzed by random effects models.

RESULTS

Overall, 72 studies encompassing 9973 children were included. The prevalence (95% CI) of PDR was 32.48% (26.08-39.21), and high among those who failed PMTCT prophylaxis (43.23% [32.94-53.82]) versus those without PMTCT-intervention ( < .01) and driven by nonnucleoside reverse transcriptase inhibitors (NNRTI) mutations (28.38% [18.74-39.08]; = .013). The prevalence of ADR was 61.43% (49.82-72.45), driven by NNRTI-mutations (65.17% [53.95-75.63]; < .001). INSTI-ADR was low (5.53% [2.49-9.53]) but emerging.

CONCLUSION

There are high burdens of PDR and ADR among CWHIV, suggesting the need to phase out pediatric NNRTIs used for either PMTCT or treatment. Emerging INSTI resistance among CWHIV highlights the relevance of drug-resistance surveillance strategies.

PROSPERO REGISTRATION NO

CRD42023470034.

摘要

引言

预防母婴传播艾滋病病毒（PMTCT）失败以及儿科治疗面临的挑战导致感染艾滋病病毒的儿童（CWHIV）出现治疗前耐药（PDR）和获得性耐药（ADR）。

方法

纳入并通过随机效应模型分析2010年至2024年间发表的关于CWHIV中PDR和ADR的干预性和观察性数据。

结果

总体而言，纳入了72项研究，涉及9973名儿童。PDR的患病率（95%CI）为32.48%（26.08 - 39.21），在PMTCT预防失败的儿童中患病率较高（43.23%[32.94 - 53.82]），与未接受PMTCT干预的儿童相比差异有统计学意义（<.01），且由非核苷类逆转录酶抑制剂（NNRTI）突变所致（28.38%[18.74 - 39.08]； =.013）。ADR的患病率为61.43%（49.82 - 72.45），由NNRTI突变所致（65.17%[53.95 - 75.63]； <.001）。整合酶链转移抑制剂（INSTI）相关耐药较低（5.53%[2.49 - 9.53]）但呈上升趋势。