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antiretroviral therapy related adverse effects:Can sub-Saharan Africa cope with the new“test and treat”policy of the World Health Organization?

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Infectious Diseases of Poverty 2017年第1期6卷 212-216页

作者： Jobert Richie N.Nansseu Jean Joel R.Bigna Department of Public Health Faculty of Medicine and Biomedical Sciences of the University of YaoundeIPO Box 1364YaoundeCameroon Sickle Cell Disease Unit Mother and Child Centre of the Chantal Biya FoundationYaoundeCameroon Department of Epidemiology and Public Health Centre Pasteur of CameroonYaoundeCameroon Faculty of Medicine University of Paris Sud XILe Kremlin BicêtreParisFrance

Background:Recent studies have shown that early antiretroviral therapy(ART)initiation results in significant HIV transmission reduction.This is the rationale behind the“test and treat”policy of the World Health Organization(WHO).Implementation of this policy will lead to an increased incidence of ART-related adverse effects,especially in sub-Saharan Africa(SSA).Is the region yet ready to cope with such a challenging issue?Main body:The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS,but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities,and the situation will get worse in the near future.Indeed,ART is associated with an increased risk of developing cardiovascular disease,lipodystrophy,prediabetes and overt diabetes,insulin resistance and hyperlactatemia/lactic acidosis.The prevalence of these disorders is already high in SSA,and the situation will be exacerbated by the implementation of the new WHO recommendations.Most SSA countries are characterized by(extreme)poverty,very weak health systems,inadequate and low quality of health services,inaccessibility to existing health facilities,lack of(qualified)health personnel,lack of adequate equipment,inaccessibility and unaffordability of medicines,and heavy workload in a context of a double burden of disease.Additionally,there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA,to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan.These are required if we are to anticipate and effectively prevent this upcoming burden.Conclusion:While SSA would be the first region to experience the huge benefits of implementing the“test and treat”policy of the WHO,the region is not yet prepared to manage the consequential increased burden of ART-related toxic and metabolic complications.Urgent measures should

关键词： HIV/AIDS Test and treat 90-90-90 antiretroviral therapy Sub-Saharan Africa

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HIV-1 Subtype Diversity and Factors Affecting Drug Resistance among Patients with Virologic Failure in antiretroviral therapy in Hainan Province,China,2014–2020

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生物医学与环境科学:英文版 2023年第9期36卷 800-813页

作者： YU De E XU Yu Jun LI Mu YANG Yuan LIANG Hua Yue ZHONG Shan Mei QIN Cai LAN Ya Nan LI Da Wei YU Ji Peng PANG Yuan QIN Xue Qiu LIANG Hao ZHU Kao Kao YE Li LIANG Bing Yu Guangxi Key Laboratory of AIDS Prevention and Treatment School of Public HealthGuangxi Medical UniversityNanning 530021GuangxiChina International School of Public Health and One Health Hainan Medical UniversityHaikou 571199HainanChina Prevention and Treatment Department the Fifth People's Hospital of Hainan Province&Affiliated Dermatology Hospital of Hainan Medical UniversityHaikou 570102HainanChina Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry Life Sciences InstituteGuangxi Medical UniversityNanning 530021GuangxiChina Oncology Medical College Guangxi Medical UniversityNanning 530021GuangxiChina The First Clinical Medical College Guangxi Medical UniversityNanning 530021GuangxiChinaGuangxi Key Laboratory of AIDS Prevention and TreatmentSchool of Public HealthGuangxi Medical UniversityNanning 530021GuangxiChina

Objective This study aimed to determine the HIV-1 subtype distribution and HIV drug resistance(HIVDR)in patients with ART failure from 2014 to 2020 in Hainan,China.Methods A 7-year cross-sectional study was conducted among HIV/AIDS patients with ART failure in Hainan.We used online subtyping tools and the maximum likelihood phylogenetic tree to confirm the HIV subtypes with pol sequences.Drug resistance mutations(DRMs)were analyzed using the Stanford University HIV Drug Resistance Database.Results A total of 307 HIV-infected patients with ART failure were included,and 241 available pol sequences were obtained.Among 241 patients,CRF01_AE accounted for 68.88%,followed by CRF07_BC(17.00%)and eight other subtypes(14.12%).The overall prevalence of HIVDR was 61.41%,and the HIVDR against non-nucleoside reverse transcriptase inhibitors(NNRTIs),nucleotide reverse transcriptase inhibitors(NRTIs),and protease inhibitors(PIs)were 59.75%,45.64%,and 2.49%,respectively.Unemployed patients,hypoimmunity or opportunistic infections in individuals,and samples from 2017 to 2020 increased the odd ratios of HIVDR.Also,HIVDR was less likely to affect female patients.The common DRMs to NNRTIs were K103N(21.99%)and Y181C(20.33%),and M184V(28.21%)and K65R(19.09%)were the main DRMs against NRTIs.Conclusion The present study highlights the HIV-1 subtype diversity in Hainan and the importance of HIVDR surveillance over a long period.

关键词： HIV-1 subtypes antiretroviral therapy Virological failure Drug resistance

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Partial recovery of disturbed V-J pairing profiles of T-cell receptor in people living with HIV receiving long-term antiretroviral therapy

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Science China(Life Sciences) 2021年第1期64卷 152-161页

作者： Guoli Li Jiarui Li Henghui Zhang Yu Zhang Di Liu Yu Hao Junyan Han Juan Du Liuluan Zhu Yongqin Zeng Bei Li Rui Li Chuan Song Fujie Zhang Chen Chen Hongxin Zhao Hui Zeng Institute of Infectious Diseases Beijing Ditan HospitalCapital Medical UniversityBeijing100015China Beijing Key Laboratory of Emerging Infectious Diseases Beijing100015China Clinical and Research Center of Infectious Diseases Beijing Ditan HospitalCapital Medical UniversityBeijing100015China Computational Virology Group Center for Bacteria and Virus Resources and ApplicationWuhan Institute of VirologyChinese Academy of SciencesWuhan430071China University of Chinese Academy of Sciences Beijing101408China

Chronic human immunodeficiency virus(HIV) infection not only causes a gradual loss of CD4~+T cells but also leads to a disturbance of the T cell receptor(TCR) repertoire. In people living with HIV(PLWH), monitoring TCR repertoire is challenged by the inconsistency of complementarity determining region 3(CDR3) and limited cell numbers in clinical samples. Thus, a quantitative method is necessary for monitoring the TCR repertoire in PLWH.We characterized the TCR V-J pairing profile of na?ve and memory CD4~+T cells in healthy donors, HIV-infected antiretroviral therapy(ART)-na?ve patients and long-term(over5 years) ART-experienced patients by performing TCR sequencing. We developed a V-J index with 18 parameters which were subdivided into five categories(expression coverage, cumulative percentage of the top tenth percentile, diversity, intra-individual similarity and inter-individual similarity). In ART-na?ve patients, 14 of the 18 parameters were significantly altered.Long-term ART recovered ten parameters. The four unrecovered parameters were related to inter-individual similarity.Therefore, these findings indicate that long-term ART could only partially recover TCR V-J pairs and introduce newly impacted V-J pairs. Moreover, these results provide new insights into the V-J pairing of the TCR and into the disturbance of TCR repertoire in HIV infection.

关键词： acquired immune deficiency syndrome human immunodeficiency virus antiretroviral therapy T cell receptor V-J pairing

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Efficacy and safety of Mianyi granules(免疫Ⅱ颗粒) for reversal of immune nonresponse following antiretroviral therapy of human immunodeficiency virus-1:a randomized,double-blind,multi-center,placebo-controlled trial

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Journal of Traditional Chinese Medicine 2022年第3期42卷 432-438页

作者： LIU Ying ZOU Wen XIAN Qingfei DENG Xin ZHANG Fuchun WANG Li LI Yonghong LUN Wenhui WANG Jian Traditional Chinese Medicine Center for Acquired Immune Deficiency Syndrome Prevention and Treatment China Academy of Chinese Medical SciencesBeijing 100700China Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine Nanning 530011China Infectious Disease Department of Guangzhou Eighth People’s Hospital Guangzhou 510060China Internal Medicine Department of Traditional Chinese Medicine Yunnan Provincial Academy of Traditional Chinese MedicineKunming 650031China Department of Hepatology Shenyang Sixth People’s HospitalShenyang 110006China Department of Dermatology Beijing Ditan HospitalBeijing 100015China

OBJECTIVE:To investigate whether Mianyi granules(免疫Ⅱ颗粒)are effective and safe in reversing immune nonresponse following antiretroviral therapy(ART)in individuals with human immunodeficiency virus(HIV)infection.METHODS:Randomized,double-blind,multi-center,placebo-controlled trial(factorial design)of daily oral Mianyi granules versus placebo for 72 weeks.A total of 361 HIV-positive individuals receiving ART at five ClassⅢGradeⅠhospitals in China between September 2013 and January 2016 completed the study.The primary endpoints were frequencies of CD3+,CD4+,CD8+,and CD45 RA+cells at seven timepoints over the 72 weeks.Secondary endpoints included viral loads,clinical symptoms,and quality of life at 72 weeks.RESULTS:A total of 400 participants were enrolled in the study and randomized,of whom 361 completed the study:189 individuals(140 men and 49 women)in the Mianyi granule group and 172 individuals(135 men and 37 women)in the placebo group.In the intent-to-treat population,CD4+T cell counts increased from(193±71)cells/mm^(3)at baseline to(288±131)cells/mm^(3)posttreatment in the Mianyi granule group and from(200±75)cells/mm^(3)at baseline to(264±124)cells/mm^(3)posttreatment in the placebo group.Patients treated with Mianyi granule had higher increases in CD4+T cell counts than those treated with placebo(P=0.045).Reversal of immune nonresponse was defined as a CD4+T cell increase of more than 100 cells/mm^(3).After treatment for 72 weeks,Mianyi granule was effective in reversing immune nonresponse in a higher proportion of individuals(20.2%)compared with placebo(9.7%).CD45 RA+cell counts increased from(34±32)cell/mm^(3)at baseline to(51±61)cells/mm^(3)post-treatment in the Mianyi granule group and from(37±33)cells/mm^(3)at baseline to(48±37)cells/mm^(3)post-treatment in the placebo group.Mianyi granules were more effective than placebo in increasing CD45 RA+cell counts.CONCLUSIONS:In ART-treated HIV-positive adults with immune nonresponse,treatment with Mianyi granules for 72 weeks was safe and significantly increased

关键词： HIV-1 immunity antiretroviral therapy treatment outcome safety Mianyi granules

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Pretreatment HIV drug resistance in adults initiating antiretroviral therapy in China,2017

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Infectious Diseases of Poverty 2020年第3期9卷 65-73页

作者： Rui-Hua Kang Shu-Jia Liang Yan-Ling Ma Shu Liang Lin Xiao Xin-Hui Zhang Hong-Yan Lu Xiao-Qin Xu Shui-Bin Luo Xiao-Guang Sun Lin Chen Jian-Mei He Guo-Hui Wu Ling-Jie Liao Hui Xing Yi-Ming Shao Yu-Hua Ruan State Key Laboratory of Infectious Disease Prevention and Control(SKLID) National Center for AIDS/STD Control and Prevention(NCAIDS)Chinese Center for Disease Control and Prevention(China CDC)Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases155 Changbai RoadChangping DistrictBeijingPR China Guangxi Center for Disease Control and Prevention NanningGuangxiChina Yunnan Center for Disease Control and Prevention KunmingYunnanChina Sichuan Center for Disease Control and Prevention ChengduSichuanChina Liangshan Center for Disease Control and Prevention Liangshan prefectureSichuanChina Guizhou Center for Disease Control and Prevention GuiyangGuizhouChina Beijing Center for Disease Control and Prevention BeijingChina Jiangsu Center for Disease Control and Prevention NanjingJiangsuChina Neijiang Center for Disease Control and Prevention NeijiangSichuanChina Shandong Center for Disease Control and Prevention JinanShandongChina Shenzhen Center for Disease Control and Prevention ShenzhenGuangdongChina Hunan Center for Disease Control and Prevention ChangshaHunanChina Chongqing Center for Disease Control and Prevention ChongqingChina

Background:After the scale-up of antiretroviral therapy(ART)for HIV infected people,increasing numbers of patients have pretreatment drug resistance(PDR).In this study,the prevalence of PDR was evaluated in adults initiating antiretroviral therapy in China.Methods:Blood samples were obtained from 1943 patients who initiated antiretroviral therapy(ART)in 2017 from 13 provinces or cities in China.Pol sequences were used to analyze drug resistance and construct transmission networks.Logistic regression model was used to estimate the potential factors associated with PDR.Results:In total,1711 eligible patients(76.0%male;87.8%aged≥25 years)were included,of which 117(6.8%)had PDR.The highest rates of PDR were 12.2%in Liangshan Prefecture of Sichuan and 9.3 and 8.9%in Dehong and Lincang Prefecture of Yunnan.A multivariate logistic regression analysis revealed that PDR was significantly higher among intravenous drug users(adjusted Odds Ratio(aOR)=2.64,95%CI:1.57–4.44)and individuals from Liangshan,Dehong,and Lincang(aOR=2.04,95%CI:1.26–3.30).In total,754 sequences were used to generate 164 transmission networks.Five transmission networks had two or three sequences containing the same mutations,two networks contained subjects from Liangshan,and one network contained subjects from Dehong.Conclusions:Overall,the PDR prevalence was moderate,with a particularly high prevalence in areas with severe HIV epidemics.These results indicate the importance of continuous PDR monitoring in patients initiating antiretroviral therapy.

关键词： HIV Pretreatment drug resistance Transmission network antiretroviral therapy

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Impact of antiretroviral therapy on the Spread of Human Immunodeficiency Virus in Chaoyang District, Beijing, China： Using the Asian Epidemic Model

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Chinese Medical Journal 2017年第1期130卷 32-38页

作者： Li-Li Tao Min Liu Shu-Ming Li Jue Liu Shu-Lin Jiang Li-Juan Wang Feng-Ji Luo Ning Wang Department of Epidemiology and Biostatistics School of Public Health Peking University Beijing 100191 China Department of STD and AIDS Prevention and Control Beijing Chaoyang District Centre for Disease Control and Prevention Beijing 100021 China National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Beijing 102206 China

Background： Successful antiretroviral therapy （ART） has been demonstrated to be effective in reducing the infectivity of human immunodeficiency virus （HIV）. We conducted a study to predict the potential effect of ART on the spread of HIV in Chaoyang District, Beijing, China, using the Asian Epidemic Model （AEM）. Methods： The AEM baseline workbook was used to determine the current infection status and to project the future spread of HIV under current conditions. We changed the input on the ART coverage from 2014 to 2025 and also modified the treatment eligibility in the AEM intervention workbook, in order to allow for analysis of the projected downstream impact of ART. Results： By gradually increasing the ART coverage rate from 29.7% （rate of 2013） to 40.0%, 50.0%, 60.0%, 70.0%, 80.0%, and 90.0% （at CD4＋ ≤350 cells/μl）, and by changing the dates of coverage from 2014 to 2020, the number of new infections showed a cumulative decline of 0.60%, 1.59%, 2.94%, 5.33%, 9.32%, and 14.98%, respectively. After 2020, the projected rates of infection rebounded slightly, so with the exception of the years with very high coverage （90.0%）, new infections continued to decrease. When we changed the initial threshold of therapy to CD4＋ cell counts ≤500 cells/μl, new infections decreased 6.00%, 11.64%, 15.92%, 21.11%, 26.92%, 33.05%, and 38.75%, respectively, under varying ART coverages. Conclusion： Our study demonstrates that the early initiation of ART for people living with HIV/acquired immune deficiency syndrome （AIDS） has a positive effect in slowing the spread of HIV.

关键词： antiretroviral therapy Asian Epidemic Model Human Immunodeficiency Virus Impact Transmission

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Effect of treatment course of comprehensive intervention with Traditional Chinese Medicine on mortality of acquired immunodeficiency syndrome patients treated with combined antiretroviral therapy

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Journal of Traditional Chinese Medicine 2016年第4期36卷 411-417页

作者： Guo Huijun Wang Jian Li Zhengwei Jiang Ziqiang Xu Qianlei Xu Liran Department of Acquired Immune Deficiency Syndrome AIDS Treatment and Research Center the First Affiliated Hospital of Henan University of Traditional Chinese Medicine Traditional Chinese Medicine Center for Acquired Immune Deficiency Syndrome Prevention and Treatment China Academy of Traditional Chinese Medicine

OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.

关键词： Acquired immunodeficiency syndrome antiretroviral therapy highly active Mortality Medicine Chinese traditional Retrospective cohort study

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Effects of viremia and CD4 recovery on gut“microbiome-immunity”axis in treatment-na?ve HIV-1-infected patients undergoing antiretroviral therapy

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World Journal of Gastroenterology 2022年第6期28卷 635-652页

作者： Edda Russo Giulia Nannini Gaetana Sterrantino Seble Tekle Kiros Vincenzo Di Pilato Marco Coppi Simone Baldi Elena Niccolai Federica Ricci Matteo Ramazzotti Marco Pallecchi Filippo Lagi Gian Maria Rossolini Alessandro Bartoloni Gianluca Bartolucci Amedeo Amedei Department of Clinical and Experimental Medicine University of FlorenceFlorence 50134Italy Department of Surgical Sciences and Integrated Diagnostics University of GenoaGenoa 16126Italy Department of Biomedical Experimental and Clinical"Mario Serio"University of FlorenceFlorence 50134Italy Microbiology and Virology Unit Florence Careggi University HospitalUniversity of FlorenceFlorence 50134Italy Department of Neurosciences PsychologyDrug Research and Child HealthUniversity of FlorenceFlorence 50019Italy

BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and buty

关键词： HIV antiretroviral therapy Microbiome-immunity axis Microbiota Cytokines Short chain fatty acid Inflammation Immunological responders Viremia

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Glucose metabolism continuous deteriorating in male patients with human immunodeficiency virus accepted antiretroviral therapy for 156 weeks

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World Journal of Diabetes 2023年第3期14卷 299-312页

作者： Da-Feng Liu Xin-Yi Zhang Rui-Feng Zhou Lin Cai Dong-Mei Yan Li-Juan Lan Sheng-Hua He Hong Tang Department of Internal Medicine Public Health and Clinical Center of ChengduChengdu 610061Sichuan ProvinceChina Department of Endocrinology and Metabolism Sichuan University West China HoapitalChengdu 610041Sichuan ProvinceChina Department of Infectious Disease Public Health and Clinical Center of ChengduChengdu 610061Sichuan ProvinceChina Center of Infectious Disease Sichuan University West China HoapitalChengdu 610041Sichuan ProvinceChina

BACKGROUND The dynamic characteristics of glucose metabolism and its risk factors in patients living with human immunodeficiency virus(PLWH)who accepted primary treatment with the efavirenz(EFV)plus lamivudine(3TC)plus tenofovir(TDF)(EFV+3TC+TDF)regimen are unclear and warrant investigation.AIM To study the long-term dynamic characteristics of glucose metabolism and its contributing factors in male PLWH who accepted primary treatment with the EFV+3TC+TDF regimen for 156 wk.METHODS This study was designed using a follow-up design.Sixty-one male treatmentnaive PLWH,including 50 cases with normal glucose tolerance and 11 cases with prediabetes,were treated with the EFV+3TC+TDF regimen for 156 wk.The glucose metabolism dynamic characteristics,the main risk factors and the differences among the three CD4+count groups were analyzed.RESULTS In treatment-naive male PLWH,regardless of whether glucose metabolism disorder was present at baseline,who accepted treatment with the EFV+3TC+TDF regimen for 156 wk,a continuous increase in the fasting plasma glucose(FPG)level,the rate of impaired fasting glucose(IFG)and the glycosylated hemoglobin(HbA1c)level were found.These changes were not due to insulin resistance but rather to significantly reduced isletβcell function,according to the homeostasis model assessment ofβcell function(HOMA-β).Moreover,the lower the baseline CD4+T-cell count was,the higher the FPG level and the lower the HOMA-βvalue.Furthermore,the main risk factors for the FPG levels were the CD3+CD8+cell count and viral load(VL),and the factors contributing to the HOMA-βvalues were the alanine aminotransferase level,VL and CD3+CD8+cell count.CONCLUSION These findings provide guidance to clinicians who are monitoring FPG levels closely and are concerned about IFG and decreased isletβcell function during antiretroviral therapy with the EFV+3TC+TDF regimen for long-term application.

关键词： Human immunodeficiency virus antiretroviral therapy Fasting plasma glucose Dynamic change Long-term

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

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Infectious Diseases of Poverty 2021年第2期10卷 72-72页

作者： Hafte Kahsay Kebede Lillian Mwanri Paul Ward Hailay Abrha Gesesew 不详 College of Medicine and Public Health Flinders UniversityAdelaideAustralia

Background:It is known that'drop out'from human immunodeficiency virus(HIV)treatment,the so called lost-to-follow-up(LTFU)occurs to persons enrolled in HIV care services.However,in sub-Saharan Africa(SSA),the risk factors for the LTFU are not well understood.Methods:We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA.A systematic search of literature using identified keywords and index terms was conducted across five databases:MEDLINE,PubMed,CINAHL,Scopus,and Web of Science.

关键词： antiretroviral therapy Defaulting Discontinuation HIV Lost to follow up Meta-analysis Systematic review Sub-Sharan Africa

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