The Magnitude and Patterns of Acquired Drug Resistance Mutations and Circulating HIV-1 Subtypes in HIV Patients in Tanzania, a Systematic Review and Meta-Analysis

Abstract

The emergence and spread of HIV drug resistance mutations (DRMs) pose a threat to current and future treatment options. To inform policy, this review aimed to determine the magnitude and patterns of DRMs in patients on ART in Tanzania. A systematic literature search was conducted in MEDLINE through PubMed, Embase, and CINAHL up to December 2024. A total of 9685 HIV patients from 23 eligible studies were analyzed. The prevalence of virological failure in studies that used a threshold of >1000 and >400 copies/mL was 24.83% (95% CI: 17.85-32.53%) and 36.94% (95% CI: 24.79-50.00%), respectively. Major DRMs were observed at 87.61% (95% CI: 76.25-95.91%). A decrease in prevalence was observed in studies conducted from 2019, with a pooled prevalence of 62.15% (95% CI: 31.57-88.33%). The most frequently observed HIV-1 subtypes were subtype C at 36.20% (95% CI: 30.71-41.85%), A1 at 33.13% (95% CI: 28.23-38.20%), and subtype D at 16.00% (95% CI: 11.41-21.12%), while recombinant forms of the virus were observed at 13.29% (95% CI: 9.79-17.17%). The prevalence of DRMs against NRTIs and NNRTIs was significantly high, while that against INSTIs and PIs was low, supporting the continued use of PI- and INSTI-based regimens in Tanzania and the need for continued surveillance of DRMs.