HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol
Abstract Background Sub-Saharan Africa carries the greatest burden of HIV-infection with increasing drug resistance burden, which requires improved patient management and monitoring. Current WHO recommendations suggest transitioning to dolutegravir-based (adults) or raltegravir-based-regimens (neona...
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Format: | Article |
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BMC
2020-04-01
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Series: | Systematic Reviews |
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Online Access: | http://link.springer.com/article/10.1186/s13643-020-01356-z |
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doaj-eea796ee281548d799fb5de15db43bc1 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ezechiel Ngoufack Jagni Semengue Maria Mercedes Santoro Valantine Ngum Ndze Beatrice Dambaya Desiré Takou Georges Teto Alex Durand Nka Lavinia Fabeni Alison Wiyeh Francesca Ceccherini-Silberstein Vittorio Colizzi Carlo-Federico Perno Joseph Fokam |
spellingShingle |
Ezechiel Ngoufack Jagni Semengue Maria Mercedes Santoro Valantine Ngum Ndze Beatrice Dambaya Desiré Takou Georges Teto Alex Durand Nka Lavinia Fabeni Alison Wiyeh Francesca Ceccherini-Silberstein Vittorio Colizzi Carlo-Federico Perno Joseph Fokam HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol Systematic Reviews HIV-1 Integrase Dolutegravir Drug resistance Sub-Saharan Africa |
author_facet |
Ezechiel Ngoufack Jagni Semengue Maria Mercedes Santoro Valantine Ngum Ndze Beatrice Dambaya Desiré Takou Georges Teto Alex Durand Nka Lavinia Fabeni Alison Wiyeh Francesca Ceccherini-Silberstein Vittorio Colizzi Carlo-Federico Perno Joseph Fokam |
author_sort |
Ezechiel Ngoufack Jagni Semengue |
title |
HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol |
title_short |
HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol |
title_full |
HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol |
title_fullStr |
HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol |
title_full_unstemmed |
HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocol |
title_sort |
hiv-1 integrase resistance associated mutations and the use of dolutegravir in sub-saharan africa: a systematic review and meta-analysis protocol |
publisher |
BMC |
series |
Systematic Reviews |
issn |
2046-4053 |
publishDate |
2020-04-01 |
description |
Abstract Background Sub-Saharan Africa carries the greatest burden of HIV-infection with increasing drug resistance burden, which requires improved patient management and monitoring. Current WHO recommendations suggest transitioning to dolutegravir-based (adults) or raltegravir-based-regimens (neonates) for initial antiretroviral therapy (ART) and as a suitable alternative in cases of multi-resistance in resource-limited settings. This review aims at synthesizing the current knowledge on dolutegravir use and integrase resistance-associated mutations found before the wide use of dolutegravir-based regimens. Methods This systematic review will include randomized and non-randomized trials, cohort, and cross-sectional studies published on dolutegravir use or integrase resistance-associated mutations in Sub-Saharan Africa. Searches will be conducted (from 2007 onwards) in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILAC), Web of Science, African Journals Online, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Hand searching of the reference lists of relevant reviews and trials will be conducted and we will also look for conference abstracts. We will include studies of adults and/or children exposed to integrase inhibitors-based therapies; especially dolutegravir or raltegravir (which is our intervention of interest as compared to other antiretroviral regimens). We will exclude studies of patients with specific co-morbidities such as tuberculosis or opportunistic infections. Primary outcomes will be “the rate of viral suppression” and “the level of drug resistance” on integrase inhibitor-based regimens among patients in Sub-Saharan Africa. Secondary outcomes will be “the effect of baseline viremia on viral suppression,” “the effect of treatment duration on viral suppression,” “the proportion of patients with immune recovery,” “the rate of non-adherence,” “rate of adverse events;” “drug resistance according to different integrase inhibitor-based regimens,” and “drug resistance according to viral subtypes/recombinants.” Two reviewers will independently screen titles and abstracts, assess the full texts for eligibility, and extract data. If data permits, random effects models will be used where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, sex, baseline viremia, CD4 following treatment, treatment duration, and adherence level). Discussion This review will help to strengthen evidence on the effectiveness of integrase strand transfer inhibitors by contributing to current knowledge on the use of dolutegravir and/or raltegravir (especially for neonates) in Sub-Saharan Africa. Results will therefore help in setting-up baseline data for an optimal management of people living with HIV as Sub-Saharan African countries are transitioning to dolutegravir-based regimens. Evidence will also support HIV/AIDS programs in identifying gaps and actions to be undertaken for improved long-term care and treatment of people living with HIV in Sub-Saharan Africa. Systematic review registration PROSPERO CRD42019122424 |
topic |
HIV-1 Integrase Dolutegravir Drug resistance Sub-Saharan Africa |
url |
http://link.springer.com/article/10.1186/s13643-020-01356-z |
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doaj-eea796ee281548d799fb5de15db43bc12020-11-25T02:04:54ZengBMCSystematic Reviews2046-40532020-04-01911710.1186/s13643-020-01356-zHIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: a systematic review and meta-analysis protocolEzechiel Ngoufack Jagni Semengue0Maria Mercedes Santoro1Valantine Ngum Ndze2Beatrice Dambaya3Desiré Takou4Georges Teto5Alex Durand Nka6Lavinia Fabeni7Alison Wiyeh8Francesca Ceccherini-Silberstein9Vittorio Colizzi10Carlo-Federico Perno11Joseph Fokam12Chantal Biya International Reference Centre for research on HIV/AIDS prevention and management (CIRCB)University of Rome “Tor Vergata”Faculty of Medicine and Biomedical Sciences, University of Yaoundé IChantal Biya International Reference Centre for research on HIV/AIDS prevention and management (CIRCB)Chantal Biya International Reference Centre for research on HIV/AIDS prevention and management (CIRCB)Chantal Biya International Reference Centre for research on HIV/AIDS prevention and management (CIRCB)Chantal Biya International Reference Centre for research on HIV/AIDS prevention and management (CIRCB)University of Rome “Tor Vergata”South African Medical Research Council (MRC), Cochrane South AfricaUniversity of Rome “Tor Vergata”Evangelical University of CameroonUniversity of MilanChantal Biya International Reference Centre for research on HIV/AIDS prevention and management (CIRCB)Abstract Background Sub-Saharan Africa carries the greatest burden of HIV-infection with increasing drug resistance burden, which requires improved patient management and monitoring. Current WHO recommendations suggest transitioning to dolutegravir-based (adults) or raltegravir-based-regimens (neonates) for initial antiretroviral therapy (ART) and as a suitable alternative in cases of multi-resistance in resource-limited settings. This review aims at synthesizing the current knowledge on dolutegravir use and integrase resistance-associated mutations found before the wide use of dolutegravir-based regimens. Methods This systematic review will include randomized and non-randomized trials, cohort, and cross-sectional studies published on dolutegravir use or integrase resistance-associated mutations in Sub-Saharan Africa. Searches will be conducted (from 2007 onwards) in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILAC), Web of Science, African Journals Online, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Hand searching of the reference lists of relevant reviews and trials will be conducted and we will also look for conference abstracts. We will include studies of adults and/or children exposed to integrase inhibitors-based therapies; especially dolutegravir or raltegravir (which is our intervention of interest as compared to other antiretroviral regimens). We will exclude studies of patients with specific co-morbidities such as tuberculosis or opportunistic infections. Primary outcomes will be “the rate of viral suppression” and “the level of drug resistance” on integrase inhibitor-based regimens among patients in Sub-Saharan Africa. Secondary outcomes will be “the effect of baseline viremia on viral suppression,” “the effect of treatment duration on viral suppression,” “the proportion of patients with immune recovery,” “the rate of non-adherence,” “rate of adverse events;” “drug resistance according to different integrase inhibitor-based regimens,” and “drug resistance according to viral subtypes/recombinants.” Two reviewers will independently screen titles and abstracts, assess the full texts for eligibility, and extract data. If data permits, random effects models will be used where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, sex, baseline viremia, CD4 following treatment, treatment duration, and adherence level). Discussion This review will help to strengthen evidence on the effectiveness of integrase strand transfer inhibitors by contributing to current knowledge on the use of dolutegravir and/or raltegravir (especially for neonates) in Sub-Saharan Africa. Results will therefore help in setting-up baseline data for an optimal management of people living with HIV as Sub-Saharan African countries are transitioning to dolutegravir-based regimens. Evidence will also support HIV/AIDS programs in identifying gaps and actions to be undertaken for improved long-term care and treatment of people living with HIV in Sub-Saharan Africa. Systematic review registration PROSPERO CRD42019122424http://link.springer.com/article/10.1186/s13643-020-01356-zHIV-1IntegraseDolutegravirDrug resistanceSub-Saharan Africa |