中国MSM中HIV原发耐药的Meta分析

The prevalence of HIV primary drug resistance among men who have sex with men in China:a meta-analysis

目的了解中国男男性行为人群（MSM）中艾滋病病毒（HIV）原发耐药水平。方法检索5个数据（万方、CNKI、VIP、CBM及Pubmed）并提取HIV耐药的原始数据,根据异质性检验结果,选择模型对原始数据进行合并分析。结果共纳入28个研究。中国MSM未治疗HIV感染者总耐药率、蛋白酶抑制剂（PI）耐药率、核苷类反转录酶抑制剂（NRTI）耐药率、非核苷类反转录酶抑制剂（NNRTI）耐药率分别为3.59%[95%可信区间（CI）：2.40%~4.96%]、1.69%（95%CI：0.74%~2.90%）、0.52%（95%CI：0.14%~1.05%）、0.54%（95%CI：0.16%~1.08%）。总耐药率及PI耐药率存在地区差异,华北、东北、华东地区耐药率更高些。结论当前中国MSM的HIV感染者原发耐药水平低,抗病毒治疗政策实际且可行。但是在一些高发地区,更需加强监测,以便提供最优治疗方案。

Objective This meta-analysis was to assess HIV primary drug resistance prevalence among men who have sex with men （MSM） in China. Methods We searched five electronic databases （Wanfang, CNKI, VIP, CBM and Pubmed） for studies of HIV drug resistance MSM. Abstracted drug resistance data were pooled and analyzed according to statistical test of homogeneity. Results Twenty-eight studies providing primary resistance information among MSM were eligible for this meta-analysis. The pooled nationwide rates of HIV drug resistance to total drugs, to PIs, to NRTIs, to NNRTIs among MSM were 3.59% （95% CI： 2.40-4.96%）, 1.69% （95% CI： 0. 74- 2.90%）, 0.52% （95%CI： 0.14-1. 05%）, and0.54% （95%CI： 0.16-1. 08%）, respectively. Resistances to total drugs and PIs manifested regional differences, and there were higher resistance prevalence in North China, North- east and East China. Conclusion The prevalence of HIV primary drug resistance among MSM was low in China. The current treatment strategies and interventions were practical and feasible in China. Additional surveillance for HIV drug resistance is necessary in high epidemic area to provide the optimal treatment regimens.