Prevalence of acquired and transmitted HIV drug resistance in Iran: A systematic review and Metaanalysis

Abstract

Background There are no national-level surveys about HIV drug resistance (HIVDR) in Iran. Therefore, this investigation aimed to estimate the prevalence of HIVDR among antiretroviral therapy (ART) naïve people (those without a history of ART) and people receiving ART.Method We systematically searched Scopus, PubMed, Web of Science, Embase, Iranian database, the references of studies, and google scholar till March, 2023. A random-effect model was implemented to calculate point estimate and 95% confidence interval (95% CI) for the prevalence of HIVDR in people living with HIV (PLHIV).Results Among 461 potential publications, 22 studies were included in the meta-analysis. The pooled prevalence of acquired HIVDR in people receiving ART was 34.0% (95% CI: 19.0%-50.0%) for nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), 27.0% (95% CI: 15.0% -41.0%) for non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 9.0% (95% CI: 3.0% -18.0%) for protease inhibitors (PIs). The pooled prevalence of Acquired HIVDR in treatment failure PLHIV was 50.0% (95% CI: 31.0% − 69.0%) for NRTI, 49.0% (95% CI: 29.0%-69.0%) for NNRTI, 11.0% (95% CI: 2.0% − 24.0%) for PI, and 1.0% (95% CI: 0–4.0%) for integrase inhibitors (INIs). The pooled prevalence of transmitted HIVDR in treatment naïve people was 3.0% (95% CI; 1.0%-6.0%) for NRTI, 5.0% (95% CI: 2.0%-9.0%) for NNRTI, and 0 for PIs and INIs.Conclusion The prevalence of HIVDR in Iranian treatment naïve and people receiving ART was relatively high. Without universal pretreatment HIVDR testing and more frequent routine viral load testing among PLHIV who are on ART, these numbers may go up.