The continuous rising of HIV drug resistance in low- and middle-income countries and its impact on treatment failure is a growing threat for the HIV treatment response. This review aimed to document pre-antiretroviral therapy (ART) CD4 counts, emerging drug resistance, and treatment failure in HIV-infected individuals initiating ART. We performed an online search in PubMed, Embase, Web of Science, African Index Medicus, Cochrane library, and The National Institute for Health Clinical Trials Registry of relevant articles published from January 1996 to June 2019. Of 1755 original studies retrieved, 28 were retained for final analysis. Treatment failure varied between 5% (95% confidence interval [CI]: 2.7-7.4) and 72% (95% CI: 55-89.6), while resistance varied between 1% (95% CI: 0.47-1.5) and 48% (95% CI: 28.4-67.6). Participants with a pre-ART CD4 count below 200 cell/μl and low adherence showed higher percentages of resistance and failure, while those with CD4 count above 200 showed lower resistance and failure regardless adherence levels. Most frequent resistance mutations included the M184I/V for the nucleoside reverse-transcriptase inhibitors (NRTIs), K103N, and Y181 for the non-NRTIs (NNRTIs), and L90M for the Protease inhibitors. Pre-ART CD4 count and adherence to treatment could play a key role in reducing drug resistance and treatment failure. The increased access to ART in resources limited settings should be accompanied by regular CD4 count testing, drug resistance monitoring, and continuous promotion of adherence. In addition, the rising of resistance mutations associated with NRTIs and NNRTIs, suggest that alternative ART regimens should be considered. (AIDS Rev. 2020;22:<FP>-0).

中文翻译：

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抗逆转录病毒治疗前CD4计数对耐药性和治疗失败的影响：系统评价。

低收入和中等收入国家对艾滋病毒的耐药性持续上升及其对治疗失败的影响，对艾滋病毒的治疗反应构成了越来越大的威胁。这篇综述旨在记录抗逆转录病毒治疗前（ART）CD4计数，新出现的耐药性以及发起ART的HIV感染者的治疗失败。我们在PubMed，Embase，Web of Science，African Index Medicus，Cochrane图书馆和美国国立卫生研究院临床试验注册处在线搜索了1996年1月至2019年6月发表的相关文章。在检索到的1755篇原始研究中，保留了28篇。进行最终分析。治疗失败率介于5％（95％置信区间[CI]：2.7-7.4）和72％（95％CI：55-89.6）之间，而耐药性介于1％（95％CI：0.47-1.5）和48％之间（95％CI：28.4-67.6）。ART前CD4计数低于200个细胞/微升且依从性低的参与者显示出较高的耐药性和衰竭百分率，而CD4计数大于200的参与者无论依从性水平如何，均显示出较低的耐药性和衰竭百分率。最常见的抗性突变包括：核苷逆转录酶抑制剂（NRTIs）为M184I / V，非NRTIs（NNRTIs）为K103N和Y181，蛋白酶抑制剂为L90M。ART之前的CD4计数和对治疗的依从性可能在降低耐药性和治疗失败中起关键作用。在资源有限的环境中增加抗病毒治疗的机会，应伴以定期的CD4计数测试，耐药性监测以及持续促进依从性。此外，与NRTI和NNRTI相关的抗药性突变的增加，建议应考虑使用其他抗逆转录病毒疗法。（AIDS Rev.2020; 22：<FP> -0）。