title: Emerging trends of HIV drug resistance in Chinese HIV-infected patients receiving first-line highly active antiretroviral therapy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has led to a dramatic decrease in AIDS-related morbidity and mortality through sustained suppression of human immunodeficiency virus (HIV) replication and reconstitution of the immune response. Settings like China that experienced rapid HAART rollout and relatively limited drug selection face considerable challenges in controlling HIV drug resistance (DR).
  
  
  METHODS
  We conducted a systematic review and meta-analysis to describe trends in emergent HIV DR to first-line HAART among Chinese HIV-infected patients, as reflected in the point prevalence of HIV DR at key points and fixed intervals after treatment initiation, using data from cohort studies and cross-sectional studies respectively.
  
  
  RESULTS
  Pooled prevalence of HIV DR from longitudinal cohorts studies was 10.79% (95% confidence interval [CI], 5.85%-19.07%) after 12 months of HAART and 80.58% (95% CI, 76.6%-84.02%) after 72 months of HAART. The HIV DR prevalence from cross-sectional studies was measured in treatment intervals; during the 0-12-month HAART treatment interval, the pooled prevalence of HIV DR was 11.1% (95% CI, 7.49%-16.14%), which increased to 22.92% at 61-72 months (95% CI, 9.45%-45.86%). Stratified analyses showed that patients receiving a didanosine-based regimen had higher HIV DR prevalence than those not taking didanosine (15.82% vs 4.97%). Patients infected through former plasma donation and those receiving AIDS treatment at village clinics had higher HIV DR prevalence than those infected through sexual transmission or treated at a county-level hospital.
  
  
  CONCLUSIONS
  Our findings indicate higher prevalence of HIV DR for patients with longer cumulative HAART exposure, highlighting important subgroups for future HIV DR surveillance and control.
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Huixin
authors: H
authors: Liu
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Ye
authors: Y
authors: Ma
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Yingying
authors: Y
authors: Su
authors: Department of Epidemiology, University of North Carolina, Chapel Hill.
authors: M Kumi
authors: MK
authors: Smith
authors: Traditional Chinese Medicine Center for AIDS Prevention and Treatment, China Academy of Chinese Medicine Sciences.
authors: Ying
authors: Y
authors: Liu
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Yantao
authors: Y
authors: Jin
authors: Medical Research and Biostatistics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Hongqiu
authors: H
authors: Gu
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Jing
authors: J
authors: Wu
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Lin
authors: L
authors: Zhu
authors: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention.
authors: Ning
authors: N
authors: Wang
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D044466:Asian People; D002681:China / Q000453:epidemiology; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; drug resistance; highly active antiretroviral therapy; meta-analysis