HIV-1 Antiretroviral Drug Resistance in Mozambique: A Systematic Review and Meta-Analysis

Abstract

This systematic review assessed the prevalence of transmitted and acquired HIV drug resistance (HIVDR) and the associated risk factors in Mozambique. A search of the PubMed, Cochrane, B-On, and Scopus databases up to December 2023 was conducted and included 11 studies with 1118 HIV-1 pol sequences. Drug resistance mutations (DRMs) to NNRTIs were found in 13% of the drug-naive individuals and 31% of those on ART, while NRTI resistance occurred in 5% and 10%, respectively. Dual-class resistance (NNRTI + NRTI) was detected in 2% of the drug-naive and 8% of ART-experienced individuals. DRMs to protease inhibitors (PIs) were found in 2% of the drug-naive and 5% of ART-experienced individuals. The rate of DRMs was significantly higher in Beira than in Maputo, as well as in pediatric patients than in adults and pregnant women. Subtype C predominated (94%) and was associated with lower viral loads and DRM rates as compared to the other subtypes. The high prevalence of DRMs, particularly to NNRTIs and NRTIs, highlights the need for ongoing surveillance and targeted interventions. These findings are critical for optimizing ART regimens and informing public health strategies in Mozambique, with particular attention to regions such as Beira and vulnerable populations such as pediatric patients.

Keywords: HIV drug resistance (HIVDR); Mozambique; antiretroviral therapy (ART); drug resistance mutations (DRMs); systematic review and meta-analysis.

Figure 1

The PRISMA flow chart summarizing the process of identifying, screening, and including relevant studies (n = 11) based on the specified inclusion and exclusion criteria.

Figure 2

Summary of the evaluated risk of bias domains for the included studies, according to the percentage of the scores provided by the Joanna Briggs Institute tool.

Figure 3

Susceptibility and resistance to NNRTIs and NRTIs in drug-naive subjects (a) and subjects on ART (b). HIVDR was predicted using the Stanford HIVdb algorithm score: Susceptible (0–9); Potential Low-Level Resistance (PLLR) (10–14), Low-Level Resistance (LLR) (15–29), Intermediate Resistance (IR) (30–59), and High-Level Resistance (HLR) (>60). NRTIs: ABC, Abacavir; AZT, Zidovudine; FTC, Emtricitabine; 3TC, Lamivudine; TDF, Tenofovir. NNRTIs: DOR, Doravirine; EFV, Efavirenz; ETR, Etravirine; NVP, Nevirapine; RPV, Rilpivirine.